Tips and pearls for “true” dextroposition of the aorta in tetralogy of Fallot

Abstract

Infundibular stenosis may develop secondary to ventricular septal defect, and transannular patch plasty can affect mortality and morbidity rates. Therefore, dextroposition of the aorta has been investigated in order to eliminate discrepancies in the literature. Figures and illustrations from the selected references have been investigated and "actual dextroposition of the aorta" has been evaluated as far as the aorta is visible. A careful examination of these figures revealed the following tips and pearls for accurate diagnosis of dextroposition of the aorta: Aorta and ventricular septal defect should be adjacent for a "true" dextroposition of the aorta; the plane where the aorta exits from the ventricle should penetrate the plane of the ventricular septal defect towards the right ventricle; if the aorta and ventricular septal defect intersect at one edge, the aorta may seem to be dextroposed; new diagnostic modalities are necessary to evaluate the actual dextroposition status of the aorta for the proper planning of treatment.

The Eisenmenger malformation: a morphologic study

“…8,10,11 More recently, discussions have been centred on the significance of the rightward rotation of the aortic root, engendering debates relating to the value of "dextroposition" when describing hearts characterised by overriding of the aortic root. 12,13 In this regard, one of us had suggested that the similarity between the Eisenmenger defect and tetralogy of Fallot reflected the biventricular origin of the overriding aorta, but that the differences relate to the degree of expansion of the subpulmonary infundibulum. 14 Another of us, however, had disputed the significance of this finding when considering the arrangements in which both arterial trunks arise predominantly from the right ventricle.…”

What is aortic overriding?

“…1,2 In the work that engendered the recent exchange, the authors wrote "dextroposition of the aorta occurs when the aorta overrides the interventricular septum to the right ventricular side". 3 In their discussion, however, they then stated "overriding of the aorta over the right ventricle, which occurs in the normal heart, should not be confused with dextroposition". This begs the question as to whether the aorta does override the right ventricle in the normal heart?…”

Truth relative to aortic overriding

“…I wonder who has revealed the secret of universal truth to Bozok et al? 1 Their abrogation of this quality to themselves is more remarkable when they suggest that only four of ten possible illustrations in the textbook edited by myself and my colleagues illustrate ''true dextroposition of the aorta''. The first remarkable aspect of their interpretation is that they choose to cite the first edition of a work that now appears in its third edition.…”

“…When I read the title of the article published in the June issue entitled ''Tips and pearls for 'true' dextroposition of the aorta in tetralogy of Fallot'', 1 I was reminded of the controversy surrounding the quotation over the use of the word ''culture''. As explained in Wikipedia, the suggestion that hearing the word ''culture'' prompts the reach for one's revolver has been dedicated to various members of the Nazi hierarchy during the second World War.…”

“…It was this particular feature, namely biventricular connection of the aortic valve, that was described by Fallot when offering his initial account of the entity we now name in his honour. 4 If we had continued to use this description, rather than ''aortic dextroposition'', then we could have avoided the specious argumentations as put forward by Bozok et al 1 Moreover, we should remember that the plane of space nominated by Bozok and colleagues as the ''ventricular septal defect'' in their Figure 3 is better described as interventricular communication. This is because the place of deficient ventricular septation extends to the undersurface of the deviated muscular outlet septum, which in tetralogy of Fallot is exclusively a right ventricular structure.…”