Pathology

  • Definitions
    • Witham and Neufeld-
      • Both great arteries originate exclusively from the right ventricle (although some override may be acceptable- not in the original definition)
      • Bilateral conus muscle- so no continuity between any semilunar valve and any atrioventricular valve.
    • Lev and Wilcox
      • One arterial trunk and at least half of the other arterial trunk emerges from the right ventricle
  • Relationship of the great arteries
    • Right posterior aorta
    • Right lateral aorta – side by side relationship- the classically described relation
    • Right anterior aorta
    • Left anterior aorta
  • Position of the VSD
    • Subaortic
    • Subpulmonary- above the septal limb of the crista supraventricularis- Taussig Bing complex
    • Doubly committed- very large and related to both semilunar valves
    • Remote- AV canal, muscular, posterior.

Embryology

  • Goor and Edwards- This is a primitive embryological condition which persists.
  • Anderson- DORV is a primitive embryological condition as Goor and Edwards have hypothesized. Leftward shift of aortic conus produces TOF while leftward shift of the pulmonary conus produces TGA.
  • Manner- abnormal orientation of tricuspid valve to left and anterior leads to DORV.