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The problems that exist when considering the anatomic variability between the channels that permit interventricular shunting

Published online by Cambridge University Press:  27 May 2014

Frédérique Bailliard
Bailliard Henry Pediatric Cardiology, Raleigh, North Carolina, United States of America
Diane E. Spicer
Congenital Heart Institute of Florida, St Petersburg, Florida, United States of America Division of Developmental Biology, MRC National Institute for Medical Research, London, United Kingdom
Timothy J. Mohun
Emeritus Founding Editor, Chapel Hill, North Carolina, United States of America
G. William Henry
Emeritus Founding Editor, Chapel Hill, North Carolina, United States of America
Robert H. Anderson*
Institute of Genetic Medicine, Newcastle University, Newcastle, United Kingdom
Correspondence to: Professor R. H. Anderson, 60 Earlsfield Road, London SW18 3DN, United Kingdom. Tel: +00 44 20 8870 4368; E-mail:


Although steps are being taken to produce a universally acceptable coding system for categorisation of the congenitally malformed hearts, obstacles remain in the search for consensus. One of the groups of lesions continuing to produce the greatest problems is those that permit interventricular shunting. The difficulties relate partly to the words used to describe the group itself, as those using Germanic languages describe the holes as ventricular septal defects, whereas those using Romance languages consider them to represent interventricular communications. The two terms, however, are not necessarily synonymous. Further disagreements relate to whether the lesions placed within the group should be sub-categorised on the basis of their geographical location within the ventricular mass, as opposed to the anatomic nature of their borders. In reality, attention to both the features is necessary if we are to recognise the full extent of phenotypic variability. In this review, we first review the evolution and theories of analysis naming the channels that permit interventricular shunting. We then demonstrate that embryologic techniques provide evidence that the changing morphology of the developing murine heart parallels the anatomy of the different lesions encountered in the congenitally malformed human heart. We suggest that, with attention paid to the temporal development of the normal murine heart, combined with a strict definition of the plane of separation between the right and left ventricular cavities, it will be feasible to produce a categorisation that is acceptable to all.

Review Articles
© Cambridge University Press 2014 

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