The conduction system in hypoplasia of the aortic tract complex

This is a study of the course of the conduction system in two cases of hypoplasia of the aortic tract complex, one with mitral stenosis and the other with mitral atresia. In both there was a posterior atrioventricular (AV) node which formed the AV bundle. In case 1 the bundle was short and bifurcated early. The branching bundle gave off a large left bundle branch (LBB), many Mahaim fibers to the septum and a small right bundle branch (RBB). In case 2 the AV node was divided into two parts which formed two posterior bundles which joined together to form a short branching bundle. Instead of a LBB there were profuse Mahaim fibers passing from the branching bundle to the depths of the ventricular septum. The RBB was large. The abnormalities seen in the conduction system particularly in the LBB are discussed from the embryologic stand-point.