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Assessing the criteria for definition of perimembranous ventricular septal defects in light of the search for consensus

Lookup NU author(s): Professor Bob Anderson


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© 2019 The Author(s). Background: Discussions continue as to whether ventricular septal defects are best categorized according to their right ventricular geography or their borders. This is especially true when considering the perimembranous defect. Our aim, therefore, was to establish the phenotypic feature of the perimembranous defect, and to establish the ease of distinguishing its geographical variants. Methods and results: We assessed unrepaired isolated perimembranous ventricular defects from six historic archives, subcategorizing them using the ICD-11 coding system. We identified 365 defects, of which 94 (26%) were deemed to open centrally, 168 (46%) to open to the outlet, and 84 (23%) to the inlet of the right ventricle, with 19 (5%) being confluent. In all hearts, the unifying phenotypic feature was fibrous continuity between the leaflets of the mitral and tricuspid valves. This was often directly between the valves, but in all instances incorporated continuity through the atrioventricular portion of the membranous septum. In contrast, we observed fibrous continuity between the leaflets of the tricuspid and aortic valves in only 298 (82%) of the specimens. When found, discontinuity most commonly was seen in the outlet and central defects. There were no discrepancies between evaluators in distinguishing the borders, but there was occasional disagreement in determining the right ventricular geography of the defect. Conclusions: The unifying feature of perimembranous defects, rather than being aortic-to-tricuspid valvar fibrous continuity, is fibrous continuity between the leaflets of the atrioventricular valves. While right ventricular geography is important in classification, it is the borders which are more objectively defined.

Publication metadata

Author(s): Tretter JT, Tran V-H, Gray S, Ta H, Loomba RS, O'Connor W, Spicer DE, Cook AC, Anderson RH

Publication type: Article

Publication status: Published

Journal: Orphanet Journal of Rare Diseases

Year: 2019

Volume: 14

Issue: 1

Online publication date: 03/04/2019

Acceptance date: 05/03/2019

ISSN (electronic): 1750-1172

Publisher: BioMed Central Ltd.


DOI: 10.1186/s13023-019-1044-2

PubMed id: 30944003


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