title: The trabecula septomarginalis (Leonardo's cord) in abnormal ventriculo-arterial connections: anatomic and morphogenetic implications.
abstract: BACKGROUND
  The abnormal ventriculo-arterial connections in atrio-ventricular concordance and situs solitus with two well developed ventricles include the range from tetralogy of Fallot throughout the different forms of double outlet right ventricle to transposition of great arteries.The infundibular septum and the trabecula septomarginalis are the fundamental anatomical landmarks for the segmental analysis.In these abnormalities there is a pathological progressive counter-clockwise rotation of the infundibular septum which divorces from the antero-superior limb of the trabecula septomarginalis and achieves his identity. Is there any anatomical evidence of a simultaneous abnormal counter-clockwise rotation of the trabecula septomarginalis?
  
  
  METHODS
  Malposition of great arteries is a generic term since all relationships have to be expected.We present specimens with anatomical evidence of a progressive counter-clockwise rotation from 0° to about 180°of the plane passing throughout the trabecula septomarginalis's limbs.
  
  
  RESULTS
  We can observe sequentially:1. Malformations in which the posterior limb of the trabecula septomarginalis is committed to the ventriculo infundibular fold: (tetralogy of Fallot, double outlet right ventricle with sub-aortic ventricular septal defect, truncus arteriosus and doubly committed ventricular septal defect);2. Malformations in which the posterior limb of the trabecula septomarginalis is committed to the infundibular septum (double outlet right ventricle with sub-pulmonary ventricular septal defect, transposition of great arteries).
  
  
  CONCLUSIONS
  1. The sequential-segmental analysis identify all the morphologies.2. The trabecula septomarginalis plane presents a progressive counter-clockwise twist on the long axis.3. Since the trabeculated portions of the ventricles are the oldest developmental components, our observations support the hypothesis that the abnormal ventriculo-arterial connections could be in relation with a pathological myocardial process during early cardio-genesis.We are promoting new studies to investigate our anatomical observations.
authors.affiliation: Paediatric Hospital Gatien de Clocheville CHRU Tours, Paediatric Cardiac Surgery, 49 Boulevard Béranger, 37044 Tours cedex 9, France. capathos@hotmail.com.
authors.forename: Athos
authors.initials: A
authors.lastname: Capuani
mesh_terms: D000015:Abnormalities, Multiple; D002102:Cadaver; D004310:Double Outlet Right Ventricle / Q000473:pathology*; D006345:Heart Septal Defects, Ventricular / Q000473:pathology*; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D014188:Transposition of Great Vessels / Q000473:pathology*
references.citation: Br Heart J. 1977 Aug;39(8):856-9
references.pmid: 901678
references.citation: J Thorac Cardiovasc Surg. 2002 Nov;124(5):984-90
references.pmid: 12407383
references.citation: Circ Res. 2002 Jul 26;91(2):87-9
references.pmid: 12142339
references.citation: Development. 2001 Aug;128(16):3179-88
references.pmid: 11688566
references.citation: Eur J Cardiol. 1976 Mar;4(1):13-24
references.pmid: 1261575
references.citation: Am J Cardiol. 1983 Mar 1;51(5):911-2
references.pmid: 6829456
references.citation: Ann Thorac Surg. 1995 Jun;59(6):1366-75
references.pmid: 7771812
references.citation: Dev Cell. 2001 Sep;1(3):435-40
references.pmid: 11702954
references.citation: J Thorac Cardiovasc Surg. 1981 Sep;82(3):405-17
references.pmid: 7278330
references.citation: Br Heart J. 1976 Apr;38(4):327-40
references.pmid: 1267978
references.citation: Circulation. 1988 Jun;77(6):1258-65
references.pmid: 3370765
references.citation: Circulation. 1960 Jun;21:1071-87
references.pmid: 13800241
references.citation: Circ Res. 2006 Feb 17;98(3):421-8
references.pmid: 16397144
references.citation: Int J Cardiol. 1988 Dec;21(3):219-32
references.pmid: 3068155
references.citation: Dev Biol. 2001 Oct 1;238(1):97-109
references.pmid: 11783996
references.citation: Ann Thorac Surg. 1995 Mar;59(3):591-7
references.pmid: 7887695
references.citation: J Thorac Cardiovasc Surg. 1972 Aug;64(2):271-81
references.pmid: 5048382
references.citation: Anat Rec. 1986 Dec;216(4):544-9
references.pmid: 3800002
references.citation: J Thorac Cardiovasc Surg. 1986 Jan;91(1):123-32
references.pmid: 3941555
references.citation: J Anat. 1989 Apr;163:231-42
references.pmid: 2606775
references.citation: Int J Cardiol. 1984 Jan;5(1):19-20
references.pmid: 6693206
references.citation: Heart. 2003 Sep;89(9):1110-8
references.pmid: 12923046
references.citation: Cardiol Young. 2005 Aug;15(4):345-64
references.pmid: 16014180
references.citation: Circulation. 1968 Sep;38(3):445-9
references.pmid: 5673595
references.citation: J Thorac Cardiovasc Surg. 1995 Sep;110(3):613-24
references.pmid: 7564427
references.citation: J Anat. 2012 Apr;220(4):336-49
references.pmid: 22296102
references.citation: Ann Thorac Surg. 1995 Feb;59(2):352-60
references.pmid: 7847949
references.citation: Cardiovasc Res. 2012 Jul 1;95(1):108-15
references.pmid: 22499773