Hostname: page-component-7c8c6479df-94d59 Total loading time: 0 Render date: 2024-03-29T10:22:02.423Z Has data issue: false hasContentIssue false

Development of the outflow tracts with reference to aortopulmonary windows and aortoventricular tunnels

Published online by Cambridge University Press:  01 December 2010

Robert H. Anderson*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States of America Cardiac Unit, Institute of Child Health, University College, London, United Kingdom Division of Basic Medical Sciences, St George’s Medical University, London, United Kingdom Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, London, United Kingdom
Andrew Cook
Affiliation:
Cardiac Unit, Institute of Child Health, University College, London, United Kingdom
Nigel A. Brown
Affiliation:
Division of Basic Medical Sciences, St George’s Medical University, London, United Kingdom
Deborah J. Henderson
Affiliation:
Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, London, United Kingdom
Bill Chaudhry
Affiliation:
Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, London, United Kingdom
Timothy Mohun
Affiliation:
National Institute of Medical Research, London, United Kingdom
*
Correspondence to: Professor R. H. Anderson, BSc, MD, FRCPath, 60 Earlsfield Road, London SW18 3DN, United Kingdom. Tel: +00 44 20 8870 4368; E-mail: r.anderson@ich.ucl.ac.uk

Abstract

Although malformations involving the ventricular outflow tracts are often described as conotruncal malformations, there is no consensus as to the lesions included in, or excluded from, this category, reflecting, in part, the current lack of precise definitions of the embryonic truncus and conus. Analysis of development of the outflow tract in terms of proximal, intermediate, and distal components greatly facilitates understanding of the morphology of the aortopulmonary window and aortoventricular tunnels. The aortopulmonary windows reflect failure to close the embryonic aortopulmonary foramen, the space between the distal end of the cushions that divide the lumen of the outflow tract itself and the dorsal wall of the aortic sac. The aortopulmonary tunnels are produced subsequent to abnormal development of the cushions themselves. The distal ends of these cushions excavate to produce the sinuses and leaflets of the arterial valves. The proximal parts of the cushions muscularise to form the subpulmonary infundibulum. The middle part of the cushion mass disappears to provide a tissue plane between the infundibulum and the aortic root. Abnormal formation of this area accounts for the various types of aortoventricular tunnel. In our brief review, we show how the anatomy of these lesions correlates with development of the outflow tract.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Kramer, TC. The partitioning of the truncus and conus and the formation of the membranous portion of the interventricular septum in the human heart. Anat Rec 1942; 71: 343370.Google Scholar
2.Moorman, AFM, Christoffels, VM, Anderson, RH, van den Hoff, MJB. The heart-forming fields: one or multiple? Phil Trans Roy Soc Biol 2007; 362: 12571265.Google Scholar
3.Goddeeris, MM, Rho, S, Petiet, A, et al. Intracardiac septation requires hedgehog-dependent cellular contributions from outside the heart. Development 2008; 135: 18871895.Google Scholar
4.Anderson, RH, Webb, S, Brown, NA, Lamers, W, Moorman, A. Development of the heart: (3) Formation of the ventricular outflow tracts, arterial valves, and intrapericardial arterial trunks. Heart 2003; 89: 11101118.Google Scholar
5.Geyer, SH, Mohun, TJ, Weninger, WJ. Visualizing vertebrate embryos with episcopic 3D imaging techniques. Scientific World Journal 2009; 16: 14231437.Google Scholar
6.Bartelings, MM, Gittenberger-de Groot, AC. The outflow tract of the heart – embryologic and morphologic correlations. Int J Cardiol 1989; 22: 289300.Google Scholar
7.Anderson, RH, Thiene, G. Categorization and description of hearts with common arterial trunk. Eur J Cardiothorac Surg 1989; 3: 481487.Google Scholar
8.Webb, S, Qayyum, SR, Anderson, RH, Lamers, WH, Richardson, MK. Septation and separation within the outflow tract of the developing heart. J Anat 2003; 202: 327342.Google Scholar
9.Anderson, RH, Brown, N, Webb, S, Henderson, D. Lessons learnt with regard to aortopulmonary window. Cardiol Young 2008; 18: 451457.Google Scholar
10.Ho, SY, Gerlis, LM, Anderson, C, Devine, WA, Smith, A. The morphology of aortopulmonary windows with regard to their classification and morphogenesis. Cardiol Young 1994; 4: 146155.Google Scholar
11.McKay, R, Anderson, RH, Cook, AC. The aorto-ventricular tunnels. Cardiol Young 2002; 12: 563580.Google Scholar
12.Levy, MJ, Lillehei, CW, Anderson, RC, Amplatz, K, Edwards, JE. Aortico-left ventricular tunnel. Circulation 1963; 27: 841853.Google Scholar
13.Becker, AE, Anderson, RH. Cardiac embryology: a help or hindrance in understanding congenital heart disease? In: Nora JJ and Takao A (eds). Congenital Heart Disease: Causes and Processes. Futura Publishing Co., Mount Kisco, New York, 1984, 339358.Google Scholar