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What is aortic overriding?

Published online by Cambridge University Press:  01 July 2014

Robert H. Anderson ,
Diane E. Spicer ,
G. William Henry ,
Cynthia Rigsby ,
Anthony M. Hlavacek  and
Timothy J. Mohun
Robert H. Anderson*
Affiliation:
Institute of Genetic Medicine, Newcastle University, Newcastle, United Kingdom
Diane E. Spicer
Affiliation:
Department of Pediatric Cardiology, University of Florida, Gainesville, Florida, United States of America Congenital Heart Institute of Florida, St Petersburg, Florida, United States of America
G. William Henry
Affiliation:
Emeritus Founding Editor, Chapel Hill, North Carolina, United States of America
Cynthia Rigsby
Affiliation:
Department of Medical Imaging, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois, United States of America
Anthony M. Hlavacek
Affiliation:
Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina, United States of America
Timothy J. Mohun
Affiliation:
Division of Developmental Biology, MRC National Institute for Medical Research, London, United Kingdom
*
Correspondence to: Professor R. H. Anderson, 60 Earlsfield Road, London SW18 3DN, United Kingdom. Tel: +00 44 20 8870 4368; E-mail: sejjran@ucl.ac.uk
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Abstract

Background: Disagreement currently exists regarding the definition of aortic dextroposition. It is suggested that the term be used interchangeably with aortic overriding, along with suggestions that the aortic valve overrides in the normal heart. The dextroposed aorta, however, does not always override the crest of the muscular ventricular septum. It is incorrect to argue that the normal aortic valve overrides. It is the cavity of the right aortic valvar sinus, rather than the valvar orifice, that sits above the muscular septum when the septum itself is intact. Therefore, to circumvent these difficulties, those using the term “dextroposition” find it necessary to distinguish “true” as opposed to “false” categories. The problems arise because “dextroposition” is remarkably ill-suited as an alternative term for aortic valvar overriding. Methods and Results: In this review, combining developmental, morphologic, and clinical data, we show how aortic overriding is best considered on the basis of biventricular connection of the aortic root in the setting of deficient ventricular septation. When analysed in this manner, it becomes an easy matter to distinguish between one-to-one and double outlet ventriculo-arterial connections. Appreciation of these features emphasises the different spatial alignments of interventricular communications as opposed to the plane of deficient ventricular septation. The concept of overriding is applicable not only to biventricular connection of the aortic root, but also the pulmonary and common arterial roots. Conclusions: The diagnostic techniques now available to the paediatric cardiologist illustrate the features of arterial valvar overriding with exquisite accuracy, informing the discussions now required for optimal decision making.

Keywords

Dextropositioninterventricular communicationtranspositiontetralogy of FallotEisenmenger defectdouble outlet right ventriclecardiac development
Type
Review Article
Information
Cardiology in the Young , Volume 25 , Issue 4 , April 2015 , pp. 612 - 625
Copyright
© Cambridge University Press 2014 

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