Sequential segmental analysis of congenitally malformed hearts: Advances for the 1990s

Although the concept of sequential segmental analysis is now widely accepted for description of congenitally malformed hearts, some aspects remain controversial. Our concepts have changed little since our initial descriptions, although we have improved the words we use to describe anatomic features. In this review, we give an outline of the steps needed, prerequisites for application of the steps, and the limited anatomic possibilities available at each step. We emphasise that our analysis of the atrial chambers, following the so-called morphologic method, uses the arrangement of the junctional morphology between the atrial appendages and the venous components of the atriums as the arbiter of morphological rightness and leftness. At the atrioventricular junctions, separate analysis of the connections of the muscle masses from the arrangements of chambers within the ventricular mass clarifies controversies concerning the “univentricular” heart. At the ventriculo-arterial junction, we focus on the need to identify a solitary arterial trunk, together with the fact that precise junctional morphology is conditioned by the semilunar attachments of the leaflets of the arterial valves. We argue that application of these principles will distinguish between those controversies which are semantic as opposed to those reflecting persisting scientific disagreements.