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Arterioventricular relations and their classification. Two specimens of arterioventricular discordance and review of published reports.

1974; BMJ; Volume: 36; Issue: 6 Linguagem: Inglês

10.1136/hrt.36.6.539

1468-201X

María V. de la Cruz, M Amoedo, Fabio Rivera, Fause Attié,

Coronary Artery Anomalies

We present a theory which makes it possible to interpret the relation between the different types of truncoconal morphologies and the position of the ventricles, to establish the atrioventricular relations, and to integrate them in the context of the corresponding visceral situs.This theory is based onfindings from experimental embryology, i.e. that the cardiac tube is constituted by three segments with specific features which appear at different de- velopmental stages and which give rise to three different heart regions (the atria, the ventricles, and the great arteries with their valvular planes) and on the evidence that the heart is formed by two cardiac primordia with different developmental potentialities.By means of this theory we systematize the relation of the great arteries and their valvular planes with the position of the ventricles and the atria with the ventricles.We divide the relations of the great arteries with the position of the ventricles into two groups: with arterioventricular concordance and with arterioventricular discordance.Arterioventricular concordance is so called because the relation between the great arteries, and their valvular planes, in the three truncoconal morphologies, allows the spatial position of the ventricles to be identified.In the morphology with crossed great arteries, a pulmonary artery directed from right to left indicates that the anatomically right ventricle is on the right, and one directed from left to right indicates that the anatomically right ventricle is on the left side.In the morphology with transposition of the great arteries, and in partial distorsion of the great arteries, an aorta placed on the right side of the pulmonary artery indicates that the anatomically right ventricle is placed on the right side and one placed on the left side of the pulmonary artery indicates that the anatomically right ventricle is placed on the left side.Arterioventricular discordance is so called because the relation of the great arteries between themselves, and their valvular planes, in the three truncoconal morphologies does not agree with the position of the ventricles, and therefore they do not permit the identification of the spatial position of these cavities.Each of the above groups comprises two subgroups: with atrioventricular concordance (anatomically right atrium connected with the anatomically right ventricle) and with atrioventricular discordance (anatomically right atrium connected with the anatomically left ventricle).Consequently there are four anatomo-embryo- logical entities.i) Arterioventricular concordance with atrioventricular concordance This entity includes the normal heart and all the congenital cardiopathies in which there is a normal atrioventricular relation and in which the relations of the great arteries with their valvular planes are concordant with the position of the ventricles.2) Arterioventricular concordance with atrioventricular discordance The most representative cardio- pathy in this group is the so-called corrected transposition of the great arteries, which arises from a develop- mental disturbance which affects simultaneously the truncus and the bulboventricular loop, causing inversion of both.3) Arterioventricular discordance with atrioventricular concordance This arises from an isolated inversion of the truncus.4) Arterioventricular discordance with atrioventricular discordance This is caused by an isolated inversion of the bulboventricular loop.The last two entities constitute an extremely rare group of cardiopathies of which two examples from our own series are presented.The reports describing this rare group are reviewed.