Surgical anatomy of atrioventricular septal defect.

This review aims to describe the anatomic spectrum of hearts classified with the collective term atrioventricular septal defect. Despite their anatomical variety, hearts with the stigmata of atrioventricular septal defect share the characteristic feature of a common atrioventricular junction guarded by a 5-leaflet valve. The lack of normal atrioventricular septation makes the aorta un-wedged, resulting in an elongated outlet length on the left ventricular surface (known as inlet-outlet disproportion). The major determinant of anatomic variations is the relationship of the bridging leaflets to the septal structures. This important relationship determines not only the level of intracardiac shunting (interatrial only, interventricular only, or both) but also the propensity for left ventricular outflow tract obstruction. Furthermore, the location of the atrioventricular node, which is posteroinferiorly displaced from the tip of the triangle of Koch, is also affected by this relationship. Understanding the cardiac anatomy in this malformation is an absolute prerequisite for successful surgery, and should be facilitated by recognizing the fundamental nature of the morphology.