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A Reassessment of the anatomical features of multiple ventricular septal defects
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  • Diane E. Spicer,
  • Robert Anderson,
  • Ujjwal Chowdhury,
  • Lakshmi Sankhyan,
  • Niwin George,
  • Niraj Pandey,
  • Saurabh Gupta,
  • Shikha Goja
Diane E. Spicer
All Children's Hospital Foundation
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Robert Anderson
1Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom Birmingham Children’s Hospital, Birmingham, United Kingdom
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Ujjwal Chowdhury
All India Institute of Medical Sciences
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Lakshmi Sankhyan
All India Institute of Medical Sciences
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Niwin George
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Niraj Pandey
All India Institute of Medical Sciences
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Saurabh Gupta
All India Institute of Medical Sciences
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Shikha Goja
All India Institute of Medical Sciences
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Abstract

Over the course of time, new developments associated with embryogenesis of the murine heart have served to clarify the developmental processes observed in the human heart. This evidence allows for creation of a developmental framework for many congenital cardiac defects. Here, we aim to solidify the framework related to the categorization of both solitary and multiple ventricular septal defects. Mice having genetic perturbation of the Furin enzyme have demonstrated perimembranous and juxta-arterial ventricular septal defects, permitting the inference to be made that these defects can co-exist with defects occurring within the apical muscular septum. Based on developmental evidence, furthermore, all interventricular communications can be placed into one of three groups, namely, those which are perimembranous, juxta-arterial, and muscular. All of the defects are described based on their borders as seen from the morphologically right ventricle. Our focus here will be on those defects within the muscular ventricular septum, recognizing that such defects can co-exist with those that are perimembranous. We discuss the differentiation of multiple discrete defects from those referred to as the ‘Swiss cheese’ variant. As we show, appropriate surgical management requires understanding of the specific terminology, as the surgical approach may differ depending on the combination of the individual defects. Data from the Society for Thoracic Surgeons revealed that both mortality and morbidity were increased in the setting of multiple as opposed to solitary ventricular septal defects.
20 Sep 2021Submitted to Journal of Cardiac Surgery
21 Sep 2021Assigned to Editor
21 Sep 2021Submission Checks Completed
23 Oct 2021Review(s) Completed, Editorial Evaluation Pending
26 Oct 2021Reviewer(s) Assigned
02 Nov 2021Editorial Decision: Accept
11 Feb 2022Published in Journal of Cardiac Surgery. 10.1111/jocs.16242