Classification of ventricular septal defects.

Abstract

London, UK summARY A classification with clinical significance is proposed for ventricular septal defect based on the study of 220 hearts with defects of the ventricular septum. All had atrioventricular and ventriculoarterial concordance with normal relations of cardiac structure. For the purpose of classification, the ventricular septum was considered as possessing muscular and membranous portions, the muscular septum itselfbeing divided into inlet, trabecular, and outlet (or infundibular) components. Defects were observed in the area of the membranous septum, termed perimembranous defects; within the muscular septum, termed muscular defects; or in the area of septum subjacent to the arterial valves, termed subarterial infundibular defects. Perimembranous defects were found extending either into the inlet, trabecular, or infundibular septa. Muscular defects were found in or between the inlet septum, trabecular septum, or infundibular septum. Review of the angiograms showed that the classification was easy to use in the catheterisation laboratory, and our observations suggest that the precision thus obtained has considerable surgical significance.In this report, we present a simplified concept for the classification of ventricular septal defects based on the study of over 200 pathological specimens with atrioventricular concordance, ventriculoarterial concordance, and usual relations of intracardiac structures. We have shown it to be useful for angiographic diagnosis and we believe it to have considerable surgical relevance. Subjects and methodsThe hearts studied were taken from the cardiopathological collections of the Cardiothoracic Institute, Brompton Hospital, London; the Royal

Clinical Spectrum of Ventricular Septal Defect in Children in a Tertiary Care Hospital

“…8 VSD were classified as perimembranous, muscular, Doubly Committed Subarterial (DCSA), and inlet VSD according to Soto's classification. 5 A thorough history, anthropometric measurement and along with chest X-ray and ECG were done in all the cases. Anthropometric procedures were performed according to standard WHO procedure.…”

“…2,3 Ventricular Septal Defect (VSD) is a developmental defect of the interventricular septum resulting from a deficiency of growth or a failure of alignment or fusion of component parts of ventricular septum. 4 Soto et al 5 classified VSD into 3 types: perimembranous, muscular and Doubly Committed Subarterial (DCSA) types depending upon the location.…”

Ventricular Septal Defect With Secondary Left Ventricular–to–Right Atrial Shunt Is Associated With a Higher Risk for Infective Endocarditis and a Lower Late Chance of Closure

“…15,16 In addition, the diagnostic hallmark for endocardial cushion defect, a left atrioventricular valve with 3 leaflets, could distinguish the endocardial cushion defect from perimembranous VSD. Aneurysmal transformation of perimembranous VSD was defined as echocardiographic evidence of tissue deposition around the margins of the VSD, which then produced a sac-like structure with distinct margins that, with each systole, protruded into the right ventricle and partially occluded the flow through the VSD.…”

Can we describe structure as well as function when accounting for the arrangement of the ventricular mass?

“…In the past, the normal ventricular septum was frequently described on the basis that it, like the ventricles themselves, possessed inlet, apical, and outlet components. 11 Subsequent reflection on the best definition of a septal structure 12 calls into question these earlier accounts. We know that chambers within the heart can be separated from each other by inflections of their walls.…”