Angiographic differentiation of types of ventricular septal defects

Defects of the ventricular septum are the commonest type of congenital cardiac malformations. A classification with axial angiography of the subtypes of ventricular septal defects is proposed on the study of 126 patients withdefects of the ventricula septum. The results were as follows; 1. The incidence of the ventricular septal defectwas 39.6% of congenital heart malformation. 2. The sex distribution of cases were 70 males and 56 females, the ageranged from 13 months to 26 years. 3. Angiographic features seen by axial angiography were as follows; a.Perimembranous defects as seen on long axial view of left ventriculogram were in continuity with aortic valve. Therelation of the defect to the tricuspid valve allows distinction of the extension of the perimembranous defect toward inlet, trabecular, or infundibular zones. This relation was determined angiographically, using the courseof the contrast medium from the left ventricle through the ventricular septal defect, opacifying the right ventricle. In inlet excavation, the shunted blood opacified the recesas between septal leaflet of tricuspid valveand interventricular septum in early phase, in infundibular excavation, opacified the recess between anterior leaflet of tricuspid valve and anterior free wall of right ventricle and in trabecular excavation, the shunted blood traversed anterior portion of tricuspid valve ring, opacified trabecular portion of right ventricle. b.Musculardefects were separated from the semilunar and atrioventricular valves. c. Subarterial defects were relatedto both semilunar valves, and they were best demonstrated on the elongated right anterior oblique view of the leftventriculogram. d. total infundibular defects were profilled in right anterior oblique 30 and long axial view,subaortic in location in both views. 4. The incidence of subtypes of ventricular septal defects evaluated by axial angiography were as follows; Subarterial type 18 cases (14.3%) Total infundibular defect 1 cases(0.8%)Perimembranous type 100 cases(79.4%) Infundibular excavation 60 cases (47.6%) Tabecular excavation 10 cases(7.9%)Inlet excavation 30 cases (23.8%) Muscular defect 7 cases(5.6%) Infundibular excavation 6 cases (4.8%) Trabecular excavation 1 cases(0.8%)