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What is aortic overriding?

Lookup NU author(s): Professor Bob Anderson


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Background: Disagreement currently exists regarding the definition of aortic dextroposition. It is suggested that the term be used interchangeably with aortic overriding, along with suggestions that the aortic valve overrides in the normal heart. The dextroposed aorta, however, does not always override the crest of the muscular ventricular septum. It is incorrect to argue that the normal aortic valve overrides. It is the cavity of the right aortic valvar sinus, rather than the valvar orifice, that sits above the muscular septum when the septum itself is intact. Therefore, to circumvent these difficulties, those using the term "dextroposition" find it necessary to distinguish "true" as opposed to "false" categories. The problems arise because "dextroposition" is remarkably ill-suited as an alternative term for aortic valvar overriding. Methods and Results: In this review, combining developmental, morphologic, and clinical data, we show how aortic overriding is best considered on the basis of biventricular connection of the aortic root in the setting of deficient ventricular septation. When analysed in this manner, it becomes an easy matter to distinguish between one-to-one and double outlet ventriculo-arterial connections. Appreciation of these features emphasises the different spatial alignments of interventricular communications as opposed to the plane of deficient ventricular septation. The concept of overriding is applicable not only to biventricular connection of the aortic root, but also the pulmonary and common arterial roots. Conclusions: The diagnostic techniques now available to the paediatric cardiologist illustrate the features of arterial valvar overriding with exquisite accuracy, informing the discussions now required for optimal decision making.

Publication metadata

Author(s): Anderson RH; Spicer DE; Henry GW; Rigsby C; Hlavacek AM; Mohun TJ

Publication type: Review

Publication status: Published

Journal: Cardiology in the Young

Year: 2015

Volume: 25

Issue: 4

Pages: 612-625

Print publication date: 01/04/2015

Online publication date: 01/07/2015

Acceptance date: 29/05/2014

ISSN (print): 1047-9511

ISSN (electronic): 1467-1107



DOI: 10.1017/S1047951114001139