The large septal arteries in normal hearts, in aortic valve disease, and in tetralogy of Fallot

The anatomy of the septal perforating arteries in normal and congenitally malformed hearts

“…Our findings endorse the recommendation of Melo and colleagues, 3,4 namely to use the medial papillary muscle as a landmark for the prediction of the site of termination of the first septal perforating artery, with the reservation that occasionally it is not the vessel itself but its largest branch that terminates there. We have now shown also that this landmark predicts the origin of the vessel, which is perpendicularly above the base of the muscle.…”

“…Large septal arteries have been previously defined as those with a minimum diameter of 1 mm. 3,4 In our series the specimens studied varied greatly in size. In the very small specimens the arteries were proportionately small.…”

“…When present, the medial papillary muscle and the constructed line perpendicular through its base were much better guides to the proximal course of the first septal artery. Melo and colleagues 3,4 advocated the use of the anterior limb of the septomarginal trabeculation as a landmark for the perforating artery in normal hearts as well as hearts with aortic valvular disease and tetralogy of Fallot. We endorse this suggestion.…”

“…their disposition in the malformed heart, 4 despite the potential for damage in operations such as the Ross procedure, correction of tetralogy of Fallot, resection of obstructive muscular subaortic stenosis, and enlargement of restrictive ventricular septal defects (VSDs) in settings such as double-outlet right ventricle, double-inlet left ventricle, and tricuspid atresia. Nonetheless, damage to these vessels can result in myocardial damage and arrhythmias.…”