Remodeling of the Embryonic Interventricular Communication in Regard to the Description and Classification of Ventricular Septal Defects
Remodeling of the Embryonic Interventricular Communication in Regard to the Description and Classification of Ventricular Septal Defects
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DOI：
10.1002/ar.24020
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发表时间：
2019-01-01
影响因子：
2
通讯作者：
Lamers, Wouter H.
中科院分区：
文献类型：
--
作者：
Anderson, Robert H.;Spicer, Diane E.;Lamers, Wouter H.
室间隔缺损是最常见的先天性心脏畸形。适当的知识所涉及的步骤完成室间隔应提供线索的形态学的不同表型。然而，目前，缺乏共识的组成部分的发展室间隔，以及如何最好地描述不同的表型在出生后的生活。我们重新评估了以前的研究致力于关闭胚胎室间交通。在此基础上，我们讨论了如何在20世纪世纪早期的研究正确地确定了步骤，参与重塑的胚胎室间孔后的阶段，在该阶段的流出道出现完全以上的腔发育的右心室。然而，从房室管完全由发育中的左心室支持的阶段起，房室孔就已经发生了重塑。我们展示了这些形态学的时间变化如何为临床上所见的不同室间隔缺损提供解释。因此，肌肉缺损代表肌性室间隔的不适当融合。膜周通道是由于胚胎持续存在的室间孔未能闭合所致。双定向和近动脉型反映了独立的肺下肌漏斗袖的形成失败。研究结果还指出了在发育过程中，发育中的房间隔和室间隔之间以及室间隔的心尖部分和心室出口部分之间适当对齐的重要性。Anat Rec，302：19-31，2019。(c)2018 Wiley Periodicals，Inc.
Ventricular septal defects are the commonest congenital cardiac malformations. Appropriate knowledge of the steps involved in completion of ventricular septation should provide clues as to the morphology of the different phenotypes. Currently, however, consensus is lacking regarding the components of the developing ventricular septum, and how best to describe the different phenotypes seen in postnatal life. We have reassessed the previous investigations devoted to closure of the embryonic interventricular communication. On this basis, we discuss how studies in the early part of the 20th century correctly identified the steps involved in the remodeling of the embryonic interventricular foramen subsequent to the stage at which the outflow tract arises entirely above the cavity of the developing right ventricle. There has, however, already been remodeling of the foramen from the stage at which the atrioventricular canal is supported exclusively by the developing left ventricle. We show how these temporal changes in morphology can provide explanations for the different ventricular septal defects seen in the clinical setting. Thus, muscular defects represent inappropriate coalescence of muscular ventricular septum. The channels that are perimembranous are due to failure of closure of the persisting embryonic interventricular foramen. Those that are doubly committed and juxta-arterial reflect failure of formation of the free-standing subpulmonary muscular infundibular sleeve. The findings also point to the importance of appropriate alignment, during development, between the developing atrial and ventricular septums, and between the apical component of the ventricular septum and the ventricular outlet components. Anat Rec, 302:19-31, 2019. (c) 2018 Wiley Periodicals, Inc.