By Hiromi Kurosawa M.D., Anton E. Becker M.D. (auth.)
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Extra resources for Atrioventricular Conduction in Congenital Heart Disease: Surgical Anatomy
Left ventricular view of same heart 53 54 Isolated Ventricular Septal Defect From a surgical point of view this type of defect is of interest, since the penetrating bundle comes very close to the posteroinferior angle of this defect, at the site where the trabecula septomarginalis and the membranous septum meet. This has immediate consequences for placement of sutures in patching the defect (Fig. 33). The diagram of this particular view shows the block of tissue removed for serial sectioning and the sites of microscopical sections shown in subsequent figures.
The illustration shows the block of tissue used for serial sectioning and the sites of the micrographs shown in subsequent figures. The penetrating bundle runs into the base of the membranous septum and is subendocardial when approached from the right side (Fig. 22a). The basic position, therefore, is similar to that seen in perimembranous inlet-type ventricular septal defect (cf. Fig. 2. lOa). ns along the crest of the inlet ventricular septum (Fig. 22b). The site of the suture is shown in Fig.
9. Right ventricular view of same heart after removal of tricuspid valve leaflets. A suture has been placed in inlet part of ventricular septum pulm nar alve outlet eptum ronary inu In u~pid sepia I c mmiure 23 medial papillary mu Ie c mple aery papillary mu Ie 24 Isolated Ventricular Septal Defect a b Fig. 10a-e. Micrographs showing course of atrioventricular conduction tissues. a Penetrating bundle. b Nonpenetrating, nonbranching bundle. c Branching bundle in relation to suture. d Origin of right bundle branch in angle between inferior and anterior margin.