ABSTRACT

I have read the well constructed review manuscript from the Authors Zeynep Eyileten, Adnan Uysalel with the title ‘Isolated ventricular septal defect in infants ‘ published EJCM 2017;5(2):27-33 with great pleasure. There are two main classifications desribed by Richard Van Praagh and by Robert Anderson. I want to give information about the main differences between the classifications of these two cardiac morphologs.

Defects between the ventricles are the commonest congenital cardiac malformations. As yet, however, there is no consensus as to how they can best be described and categorized. Although most of the cardiac structure have been extensively addressed, significant gaps continue to exist between the descriptions provided by morphologists and by those working in the clinical setting such as the cardiologists and cardiac surgeons.

Although there are several definitions depending on the localisation and the diamention of the VSD’s the two modern anatomical descriptions were made by Richard Van Praagh and Robert Anderson.

Van Praagh classify the ventricular septal defects as:

In atrioventricular canal type the VSD is located in the atrioventricular canal portion of the interventricular septum,under the tricuspid valve,and confined by the tricuspid annulus.This can ocur with or without a Common AV Canal.

Muscular VSDs are localised within the anterior, mid-ventricular, posterior or apical portion of the ventricular septum.

Membranous defectes are usually small defects localised at the membranous septum.

Conoventricular VSD occurs due to hypoplastic or malaligned conal septumand is bordered by conal septum and the septal band. If thre is membranous septal involvement, it is descibed as paramembranous or juxtamembranous. According to Van Praagh as ‘peri-‘means around and the defect doesn’t surround the membranous septum the name perimembranous is incorrect.

There are 4 subtypes:

Conal VSD is located within the conal septum. Aortic and pulmonary valves are at the superior aspect
of the defect. The remainder of the ventricular septal defect rim is bordered by the conal septal muscle.

Anderson classify the ventricular septal defecets as:

Perimembranous defects bordered by the area of continuity between one or both AV valves and the ar-terial valve

There are 4 subtypes:

Muscular ventricular defects are completely surrounded by muscular tissue.

There are 3 subtypes:

Doubly Committed Juxtaarterial defect is bordered by both arterial valves,and there is fibrous continuity of the leaflets of each of the arterial valves.

There are 2 subtypes: