How should we optimally describe complex congenitally malformed hearts?

Background. There is still no agreement on how best to describe the arrangement of complex congenitally malformed hearts. Some favor a system using short coded segmental combinations. Others favor a more descriptive approach. Methods and Results. I have reviewed my own experience in examining congenitally malformed hearts. This shows that it is possible to select in all such hearts the most constant anatomic components to define the morphology of the atrial and ventricular chambers and the arterial trunks. These components are the appendages for the atriums, the apical trabecular regions for the ventricles, and the branching pattern for the arterial trunks. Thereafter, it is possible in all hearts to base description on the fashion in which the chambers and trunks are or are not joined together, describing separately any pertinent additional morphologic features or abnormal relationships. Conclusions. By using this simple descriptive approach, which owes nothing to concepts of development, it is possible to give a basic description of each heart, and predict the location of the conduction tissues, even if the heart in question has never previously been encountered.