We observed the Trabecula Septomarginalis anatomy in malformed cardiac phenotypes reviewing the related literature and the current concepts on cardiac embryogenesis. The embryological and anatomical insights in formed cardiac phenotypes support the hypothesis that the ventriculo arterial cardiac connections in any pathological settings recapitulate an abnormal counterclockwise rotation on the ventricular base-apex axis of the primary cardiac tube in the first month of life at the Carnegie stages XIV-XVII. The Trabecula rotates and follows the development of the Right ventricle in every specific pathological formed phenotype: a teratological continuum encompassing single phenotypes. The Trabecula’s rotation at bulbar level (embryologic conus) on the septal aspect of the right ventricle links embryology to anatomy and finally to new investigations during pregnancy possibly leading up to less severe or even normal cardiac phenotypes what we refer to as Molecular Cardiac Surgery. It is beyond the scope of this paper to enter into embryological dissertations or to appraise the hitherto postulated morphogenesis of specific phenotypes. The purpose of this paper is to provide further evidence of the sequential Trabecula Septomarginalis rotation in formed phenotypes with embryological traits related to the development during the first month of life. We are currently investigating the contribution of external forces on the interventricular septum rotational process during looping in the chick heart and we are organizing a biologists network to realize a research protocol based on exosomes for early detection of Congenital Heart Disease.