Andersons pediatric cardiology 64
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absenceofcontinuitybetweentheleafletsofthearterialandatrioventricular
valves.Fourth,theremaybebilaterallydeficientinfundibulums,withcontinuity
bilaterallybetweenthearterialandtheatrioventricularvalves.Inthemselves,
thesetermsarenotspecific.Forspecificity,itisalsonecessarytoknowwhich
arterialvalvetakesoriginfromwhichventricle.Thisemphasizesthefactthat
infundibularmorphologyisindependentoftheventriculoarterialconnections.
AssociatedMalformations
Themajorityofpatientsseenwithcongenitallymalformedheartswillhavetheir
cardiacsegmentsjoinedtogetherinusualfashion,togetherwithnormal
morphologyandrelations.Insuchasetting,theassociatedmalformationwillbe
theanomaly.Thistextbookisconcernedwithdescribingthespecific
morphologicandclinicalfeaturesoftheseanomalies.Nonetheless,itisalso
necessarytopayattentiontothepositionoftheheartwithinthechestandthe
orientationofthecardiacapex.Itisalsonecessarytorecognizethattheheart
maybepositionedectopicallyoutsidethethoraciccavity.Anabnormalposition
oftheheartwithinthechestisanotherassociatedmalformationandshouldnot
beelevatedtoaprimediagnosis.Thisisnottodecrytheimportanceofan
abnormalcardiacposition,ifonlytoaidininterpretationofthe
electrocardiogram.However,knowingthattheheartismalpositionedgivesno
informationconcerningitsinternalarchitecture.Fullsequentialsegmental
analysisisneededtoestablishthecardiacstructure,andnottheotherway
around.Theheartcanbelocatedmostlyinthelefthemithorax,mostlyinthe
righthemithorax,orcentrallypositionedinthemediastinum.Thecardiacapex
canpointtotheleft,totheright,ortothemiddle.Theorientationoftheapexis
independentofcardiacposition.Bothoftheseareindependentofthe
arrangementoftheatrialappendagesandofthethoracicandabdominalorgans.
Describingaright-sidedheart,withleftwardapex,shouldbeunderstandableby
all,evenincludingthepatient.
AnnotatedReferences
AndersonRH,BeckerAE,FreedomRM,etal.
Sequentialsegmentalanalysisofcongenital
heartdisease.PediatrCardiol.1984;5:281–288.
AndersonRH,BeckerAE,TynanM,etal.The
univentricularatrioventricularconnection:
gettingtotherootofathornyproblem.AmJ
Cardiol.1984;54:822–882.
Inthesetworeviews,theEuropeanschool,
supportednowalsobythelateRobertFreedom,
recognizedthewisdomofthe“morphologic
method.”Theypointedoutthat,inso-called
heartswith“singleventricles,”or
“univentricularhearts,”itwasveryrareforthe
ventricularmasstocontainbutonechamber.In
fact,itwastheatrioventricularconnectionsthat
wereuniventricularinthesesettings.Sincethen,
theEuropeanschoolhasbaseditsdefinitions
exclusivelyonthe“morphologicmethod,”as
explainedatlengthinthischapter..
delaCruzMV,Nadal-GinardB.Rulesforthe
diagnosisofvisceralsitus,truncoconal
morphologiesandventricularinversions.Am
HeartJ.1972;84:19–32.
ThisreviewsummarizedthethoughtsoftheLatin-
