In a small proportion of Caucasian patients, but in larger
numbers of patients seen in the Far East, and in Central
and South America, the antero-superior margin of the
ventricular septal defect is not formed by the muscular
outlet septum, but is formed by fibrous continuity
between the leaflets of the aortic and pulmonary valves.
This morphology is the consequence of failure of muscularisation
of the developing outlet septum (Figure 4).
These patients, nonetheless, do have obstruction of the
right ventricular outflow tract due to the malalignment of
the fibrous remnant of the outlet septum.
The size of the ventricular septal defect can vary, but in
almost all instances, the interventricular communication
is unrestrictive, allowing for bidirectional shunting [6].
In a small proportion of Caucasian patients, but in largernumbers of patients seen in the Far East, and in Centraland South America, the antero-superior margin of theventricular septal defect is not formed by the muscularoutlet septum, but is formed by fibrous continuitybetween the leaflets of the aortic and pulmonary valves.This morphology is the consequence of failure of muscularisationof the developing outlet septum (Figure 4).These patients, nonetheless, do have obstruction of theright ventricular outflow tract due to the malalignment ofthe fibrous remnant of the outlet septum.The size of the ventricular septal defect can vary, but inalmost all instances, the interventricular communicationis unrestrictive, allowing for bidirectional shunting [6].
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