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Development and Maldevelopment of the Ventricular Outflow Tracts

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Surgery of Conotruncal Anomalies

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Abstract

In this chapter, we provide an account of cardiac development that, hopefully, will underscore the understanding of the surgical anatomy of the lesions to be contained within the overall book. The book alleges coverage of the surgical treatment of “conotruncal anomalies”. It is our belief that one of the lesions to be considered, namely congenitally correct transposition, requires abnormal looping of the developing heart tube as the primary abnormal developmental event. To put this lesion into context, therefore, we begin our account with a brief review of formation and looping of the heart tube. We then concentrate on the normal and abnormal development of the ventricular outflow tracts, although we question whether development is best considered in terms of the “conus” as opposed to the “truncus”. It is anatomically more accurate to address development of the outflow tract in terms of its proximal, intermediate, and distal components, and to consider these intrapericardial parts separately from the extrapericardial arterial pathways, which develop within the pharyngeal mesenchyme. The tripartite approach to development then permits rational explanations to be provided for formation of the ventricular outflow tract, the arterial valves and their supporting sinuses, and the intrapericardial arterial trunks. This approach to normal development permits analyses to be made of the lesions afflicting the different components, such as aortopulmonary windows, common arterial trunk, arterial valvar malformations, tetralogy of Fallot, double outlet right ventricle, and discordant ventriculo-arterial connections.

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Acknowledgements

We are indebted to Professor Pete Scambler from the Institute of Child Health, University College, London, who has permitted us to use images obtained from mice engineered in his department. We also thank Dr Robert Kelly, University of Marseilles, for ongoing discussion regarding the Tbx1 knock-out mice.

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Authors and Affiliations

  1. Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK

    Robert H. Anderson BSc, MD, FRCPath, Simon D. Bamforth BSc (Hons), PhD, Deborah J. Henderson BSc, PhD & Bill Chaudhry MBBS, MRCP, PhD

  2. Department of Pediatric Cardiology, University of Florida, Gainesville, FL, USA

    Diane E. Spicer BS

  3. Department of Pathology, Johns Hopkins All Children’s Heart Institute, St. Petersburg, FL, USA

    Diane E. Spicer BS

  4. Division of Biomedical Sciences, St George’s Hospital Medical School, Institute of Medical and Biomedical Education, St George’s University of London, London, UK

    Nigel Andrew Brown BSc, PhD

  5. Division of Developmental Biology, MRC National Institute for Medical Research, London, UK

    Timothy J. Mohun PhD

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  1. Robert H. Anderson BSc, MD, FRCPath
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  2. Simon D. Bamforth BSc (Hons), PhD
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  3. Diane E. Spicer BS
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  4. Deborah J. Henderson BSc, PhD
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  5. Bill Chaudhry MBBS, MRCP, PhD
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  7. Timothy J. Mohun PhD
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Corresponding author

Correspondence to Robert H. Anderson BSc, MD, FRCPath .

Editor information

Editors and Affiliations

  1. Royal Brompton Hospital, London, United Kingdom

    Francois Lacour-Gayet

  2. C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan, USA

    Edward L. Bove

  3. German Pediatric Heart Center, Asklepios Klinik Sankt Augustin Gmb, Sankt Augustin, Germany

    Viktor Hraška

  4. University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA

    Victor O. Morell

  5. Department of Cardiothoracic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Thomas L. Spray

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© 2016 Springer International Publishing Switzerland

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Anderson, R.H. et al. (2016). Development and Maldevelopment of the Ventricular Outflow Tracts. In: Lacour-Gayet, F., Bove, E., Hraška, V., Morell, V., Spray, T. (eds) Surgery of Conotruncal Anomalies. Springer, Cham. https://doi.org/10.1007/978-3-319-23057-3_2

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  • DOI: https://doi.org/10.1007/978-3-319-23057-3_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23056-6

  • Online ISBN: 978-3-319-23057-3

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