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Ann Thorac Surg 2004;77:1881-1882
© 2004 The Society of Thoracic Surgeons

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Editorial

The conduction tissues in congenitally corrected transposition

^a Cardiac Unit, Institute of Child Health, University College, London, United Kingdom

^* Address reprint requests to Dr Anderson, Cardiac Unit, Institute of Child Health, 30 Guilford St, London WN1N 1EH, UK
e-mail: r.anderson@ich.ucl.ac.uk

The first 20% of the full text of this article appears below.

The investigation by Hosseinpour and colleagues [1] provides important additional information concerning the location of the atrioventricular conduction tissues in patients with congenitally corrected transposition. In this setting, in most instances, the atrioventricular conduction axis takes its origin from an anomalously located atrioventricular node, rather than the regular atrioventricular node found at the apex of the triangle of Koch [2]. But this is not always the case, and, until now, no logical explanation has been given to explain why, in some cases, the atrioventricular bundle arises from a regularly positioned atrioventricular node.

Congenitally corrected transposition, of course, is the combination of discordant connections of the cardiac segments at both the atrioventricular and ventriculoarterial junctions. As such, it can exist either in the usual arrangement, or in a mirror-imaged variant. To date, as explained by Hosseinpour et al [1], in all the cases examined histologically, all those with the mirror-imaged variant ("situs inversus") have had the atrioventricular conduction axis arising posteriorly from a regularly positioned node, rather than being displaced anterosuperiorly as in the usual situation. And, as also explained by Hosseinpour et al [1], in a small minority of the cases with usual atrial arrangement ("situs solitus"), the conduction axis has been found in posterior rather than anterior location. The accepted explanation thus far for these apparently contradictory findings has been that, in . . . [Full Text of this Article]

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