Circulation, Vol 51, 723-730, Copyright © 1975 by American Heart Association
S Bharati and M Lev
The conduction systems of three hearts with single ventricle and inverted
(L-) loop and inverted (L-) transposition were studied by serial section.
The course of the conduction system was similar in all three hearts. The
regular (posterior) atrioventricular (A-V) node was rudimentary and did not
form the bundle of His. An accessory (anterior) A-V node was present in
the roof of the right atrium. This node pierced the connective tissue
adjacent to the right side of the pulmonary annulus to form the bundle of
His. The bundle proceeded into the main ventricular chamber lying on the
septum between this chamber and the small outlet chamber. It bifurcated a
varying distance from the defect in this septum. The right bundle branch
proceeded through the septal wall to the trabeculae of the outlet chamber.
The left bundle branch proceeded to caudad on the anterior wall of the main
ventricular chamber. An unusual feature in one case was the splitting of
the anterior node into two parts, one forming the bundle of His, and the
other giving off Mahaim fibers to the ventricular myocardium. The surgical
importance of avoiding the right side of the pulmonary annulus and the
region adjoining the defect is stressed.
ARTICLES
The course of the conduction system in single ventricle with inverted (L-) loop and inverted (L-) transposition
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