Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1984 Aug;52(2):164–177. doi: 10.1136/hrt.52.2.164

Double outlet right ventricle. Cross sectional echocardiographic findings, their anatomical explanation, and surgical relevance.

F J Macartney, M L Rigby, R H Anderson, J Stark, N H Silverman
PMCID: PMC481606  PMID: 6743434

Abstract

The precise method of surgical repair of double outlet right ventricle depends both on the relation of the interventricular communication to the cardiac outlets and on the course and insertion of the atrioventricular valve tension apparatus. It may be difficult to connect the interventricular communication with one or other outlet or both either because the interventricular communication is too far from the outlets or because atrioventricular tension apparatus interposes between them. This study was carried out in order to establish whether these details could be recognised preoperatively using cross sectional echocardiography. Forty two echocardiograms were reviewed retrospectively from patients with double outlet right ventricle, excluding those with atrioventricular septal defects and atrioventricular discordance. Ten further such patients were studied prospectively. The diagnosis was confirmed at open heart surgery in 19 patients. The relation of the great arteries and their outlet tracts to each other and to the interventricular communication was readily and accurately predicted. Four patients (7.7%) had no infundibular septum. The remaining 48 had such a septum. In 27 (52%) the interventricular communication was overridden by a great artery. In 14 (27%) it was roofed by the ventriculoinfundibular fold, and in 11 (21%) it was confined to the inlet or trabecular septa. The insertion of chordae tendineae limited the possible surgical options in 12 patients (23.1%) who were distributed unpredictably among the above groups. Four patients had straddling atrioventricular valves. In five, tricuspid tension apparatus inserted into the underside of the infundibular septum and, in two, into the roof of the defect. In one patient the mitral valve inserted into the defect floor. Tricuspid tension apparatus inserted into the floor of the defect in a further nine patients, but this does not compromise surgery. Thus in double outlet right ventricle cross sectional echocardiography can provide unique information necessary for planning of rational surgical management.

Full text

PDF
164

Images in this article

167Image
on p.167
169Image
on p.169
170Image
on p.170
171Image
on p.171
171Image
on p.171
172Image
on p.172
173Image
on p.173
174Image
on p.174

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson R. H., Becker A. E., Wilcox B. R., Macartney F. J., Wilkinson J. L. Surgical anatomy of double-outlet right ventricle--a reappraisal. Am J Cardiol. 1983 Sep 1;52(5):555–559. doi: 10.1016/0002-9149(83)90025-5. [DOI] [PubMed] [Google Scholar]
  2. Aziz K. U., Paul M. H., Muster A. J., Idriss F. S. Positional abnormalities of atrioventricular valves in transposition of the great arteries including double outlet right ventricle, atrioventricular valve straddling and malattachment. Am J Cardiol. 1979 Nov;44(6):1135–1145. doi: 10.1016/0002-9149(79)90179-6. [DOI] [PubMed] [Google Scholar]
  3. Bierman F. Z., Williams R. G. Prospective diagnosis of d-transposition of the great arteries in neonates by subxiphoid, two-dimensional echocardiography. Circulation. 1979 Dec;60(7):1496–1502. doi: 10.1161/01.cir.60.7.1496. [DOI] [PubMed] [Google Scholar]
  4. DiSessa T. G., Hagan A. D., Pope C., Samtoy L., Friedman W. F. Two dimensional echocardiographic characteristics of double outlet right ventricle. Am J Cardiol. 1979 Nov;44(6):1146–1154. doi: 10.1016/0002-9149(79)90180-2. [DOI] [PubMed] [Google Scholar]
  5. Gomes M. M., Weidman W. H., McGoon D. C., Danielson G. K. Double-outlet right ventricle with pulmonic stenosis. Surgical considerations and results of operation. Circulation. 1971 Jun;43(6):889–894. doi: 10.1161/01.cir.43.6.889. [DOI] [PubMed] [Google Scholar]
  6. Hagler D. J., Tajik A. J., Seward J. B., Mair D. D., Ritter D. G. Double-outlet right ventricle: wide-angle two-dimensional echocardiographic observations. Circulation. 1981 Feb;63(2):419–428. doi: 10.1161/01.cir.63.2.419. [DOI] [PubMed] [Google Scholar]
  7. Hagler D. J., Tajik A. J., Seward J. B., Mair D. D., Ritter D. G. Wide-angle two-dimensional echocardiographic profiles of conotruncal abnormalities. Mayo Clin Proc. 1980 Feb;55(2):73–82. [PubMed] [Google Scholar]
  8. Harvey J. C., Sondheimer H. M., Williams W. G., Olley P. M., Trusler G. A. Repair of double-outlet right ventricle. J Thorac Cardiovasc Surg. 1977 Apr;73(4):611–615. [PubMed] [Google Scholar]
  9. Henry W. L., Maron B. J., Griffith J. M. Cross-sectional echocardiography in the diagnosis of congenital heart disease. Identification of the relation of the ventricles and great arteries. Circulation. 1977 Aug;56(2):267–273. doi: 10.1161/01.cir.56.2.267. [DOI] [PubMed] [Google Scholar]
  10. Houston A. B., Gregory N. L., Coleman E. N. Two-dimensional sector scanner echocardiography in cyanotic congenital heart disease. Br Heart J. 1977 Oct;39(10):1076–1081. doi: 10.1136/hrt.39.10.1076. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Huhta J. C., Smallhorn J. F., Macartney F. J. Two dimensional echocardiographic diagnosis of situs. Br Heart J. 1982 Aug;48(2):97–108. doi: 10.1136/hrt.48.2.97. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Huhta J. C., Smallhorn J. F., de Leval M. R., Macartney F. J. Tricuspid valve abnormalities in DORV with subpulmonic VSD. J Thorac Cardiovasc Surg. 1982 Jul;84(1):154–155. [PubMed] [Google Scholar]
  13. Judson J. P., Danielson G. K., Puga F. J., Mair D. D., McGoon D. C. Double-outlet right ventricle. Surgical results, 1970-1980. J Thorac Cardiovasc Surg. 1983 Jan;85(1):32–40. [PubMed] [Google Scholar]
  14. Kirklin J. K., Castaneda A. R. Surgical correction of double-outlet right ventricule with noncommitted ventricular septal defect. J Thorac Cardiovasc Surg. 1977 Mar;73(3):399–403. [PubMed] [Google Scholar]
  15. Lev M., Bharati S., Meng C. C., Liberthson R. R., Paul M. H., Idriss F. A concept of double-outlet right ventricle. J Thorac Cardiovasc Surg. 1972 Aug;64(2):271–281. [PubMed] [Google Scholar]
  16. McGoon D. C. Left ventricular and biventricular extracardiac conduits. J Thorac Cardiovasc Surg. 1976 Jul;72(1):7–14. [PubMed] [Google Scholar]
  17. Moulton A. L., de Leval M. R., Macartney F. J., Taylor J. F., Stark J. Rastelli procedure for transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction. Early and late results in 41 patients (1971 to 1978). Br Heart J. 1981 Jan;45(1):20–28. doi: 10.1136/hrt.45.1.20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Piccoli G., Pacifico A. D., Kirklin J. W., Blackstone E. H., Kirklin J. K., Bargeron L. M., Jr Changing results and concepts in the surgical treatment of double-outlet right ventricle: analysis of 137 operations in 126 patients. Am J Cardiol. 1983 Sep 1;52(5):549–554. doi: 10.1016/0002-9149(83)90024-3. [DOI] [PubMed] [Google Scholar]
  19. Sanders S. P., Bierman F. Z., Williams R. G. Conotruncal malformations: diagnosis in infancy using subxiphoid 2-dimensional echocardiography. Am J Cardiol. 1982 Dec;50(6):1361–1367. doi: 10.1016/0002-9149(82)90475-1. [DOI] [PubMed] [Google Scholar]
  20. Smallhorn J. F., Tommasini G., Macartney F. J. Detection and assessment of straddling and overriding atrioventricular valves by two dimensional echocardiography. Br Heart J. 1981 Sep;46(3):254–262. doi: 10.1136/hrt.46.3.254. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Smallhorn J. F., de Leval M., Stark J., Somerville J., Taylor J. F., Anderson R. H., Macartney F. J. Isolated anterior mitral cleft. Two dimensional echocardiographic assessment and differentiation from "clefts" associated with atrioventricular septal defect. Br Heart J. 1982 Aug;48(2):109–116. doi: 10.1136/hrt.48.2.109. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Sridaromont S., Feldt R. H., Ritter D. G., Davis G. D., Edwards J. E. Double outlet right ventricle: hemodynamic and anatomic correlations. Am J Cardiol. 1976 Jul;38(1):85–94. doi: 10.1016/0002-9149(76)90067-9. [DOI] [PubMed] [Google Scholar]
  23. Sridaromont S., Ritter D. G., Feldt R. H., Davis G. D., Edwards J. E. Double-outlet right ventricle. Anatomic and angiocardiographic correlations. Mayo Clin Proc. 1978 Sep;53(9):555–577. [PubMed] [Google Scholar]
  24. Sutherland G. R., Godman M. J., Smallhorn J. F., Guiterras P., Anderson R. H., Hunter S. Ventricular septal defects. Two dimensional echocardiographic and morphological correlations. Br Heart J. 1982 Apr;47(4):316–328. doi: 10.1136/hrt.47.4.316. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Sutherland G. R., Smallhorn J. F., Anderson R. H., Rigby M. L., Hunter S. Atrioventricular discordance. Cross-sectional echocardiographic--morphological correlative study. Br Heart J. 1983 Jul;50(1):8–20. doi: 10.1136/hrt.50.1.8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Tynan M. J., Becker A. E., Macartney F. J., Jiménez M. Q., Shinebourne E. A., Anderson R. H. Nomenclature and classification of congenital heart disease. Br Heart J. 1979 May;41(5):544–553. doi: 10.1136/hrt.41.5.544. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Wilcox B. R., Ho S. Y., Macartney F. J., Becker A. E., Gelis L. M., Anderson R. H. Surgical anatomy of double-outlet right ventricle with situs solitus and atrioventricular concordance. J Thorac Cardiovasc Surg. 1981 Sep;82(3):405–417. [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES