Table E2.
Description of DORV types and associated findings
| DORV type | VSD | ASD | Valvular anomaly | Stenosis | |
|---|---|---|---|---|---|
| p01 | TGA | Subpulmonary with inlet extension | – | – | Subpulmonary and valvular |
| p02 | Side-by-side | subaortic and trabecular | – | – | Subaortic |
| p03 | TGA | inlet | Ostium primum (OP) + otium secundum (OS) | Mitral valve (MV), pulmonary valve (PV) | Subpulmonary |
| p04 | TOF | Subaortic and trabecular | OS | – | Sub-, supra-, and pulmonary (hypoplasia of PT from RPA) |
| p05 | TGA | Subpulmonary with posterior extension | OS | – | Subpulmonary and valvular |
| p06 | TGA | Subpulmonary with posterior extension and trabecular | – | Straddling tricuspid valve (TV) and MV | Subpulmonary and valvular |
| p07 | Side-by-side | Restrictive perimembraneous | – | – | subaortic (TV attaches to septal crest), outlet septum |
| p08 | TGA | Subpulmonary with posterior extension and trabecular | – | – | subpulmonary, leveled (hypoplasia PT, from LPA) |
| p09 | Side-by-side | Inlet and trabecular | – | TV straddling | RVOTO (conus + anterior pap.) |
| p10 | TGA | Subpulmonary and inlet | – | – | Subpulmonary |
| p11 | TGA | Subpulmonary | OS | – | Aortic hypoplasia, PAs dilation |
Case description with 3DVVR and 3DPHM of 3 DORV cases: p01: DORV TGA-type with severe pulmonary stenosis and subpulmonary VSD. The panel opted for an OTR after multimodality imaging step. The 3DM led in favor of a Nikaidoh due to severe pulmonary stenosis convincingly assessed after 3DVR, and confirm after the 3DPHM. An SVP was realized at the time of intervention according to medicosurgical decision. The temporal surgical expertise may explain the discrepancy. p03: TGA anteroposterior aortopulmonary orientation, with subpulmonary stenosis and inlet VSD. The pulmonary integrity suggested an ASO or OTR at multimodality imaging step. However, after the 3DVR visualization, OTR seemed more suitable due to better perceived stenotic pulmonary valve. 3DPHM confirmed the suspicion that convinced the team for an OTR. At the time of intervention, a Nikaidoh procedure was performed due to temporal surgical expertise. p05: DORV D-TGA type, with subvalvular and pulmonary stenosis, and subpulmonary VSD with posterior extension. 3DVR and 3DPHM resulted in a Nikaidoh procedure compared with a OTR after MI. In the medical records, OTR has been surgically attempted but a residual transpulmonary gradient made PVR necessary, adopting a Nikaidoh procedure. The 3DVR and 3DPHM would have facilitated the early adoption for a Nikaidoh procedure and could have reduced the operative time. p09: DORV TGA type, side-by-side aortopulmonary position, with inlet and trabeculated VSD and TV straddling as well as a medioventricular obstacle due to double conus. After multimodality imaging, SVP seemed better suited. The 3DVR brought consideration for biventricular reparation through ASO. 3DPHM changed the surgical strategy for a biventricular repair with ASO through representations of the aortic and pulmonary annuli relative matching size, the inlet VSD relation with the PV and the resectability of the second conus making a baffle from VSD to PV conceivable. Retrospectively, the original heart team decision was an SVP but peroperative findings changed the strategy for an ASO with VSD to neoartic valve baffling. The 3D modalities could have convinced for a straight away ASO. p11: DORV TGA-type, subpulmonary stenosis, hypoplastic aortic arch, and dilation of pulmonary arteries. An ASO was first considered after multimodal imaging, considering an integer pulmonary valve with a moderate dilated caliber. Then, OTR was finally preferred to ASO after 3DVR and 3DPHM, due to better appreciation of dilated pulmonary annulus at increased risk of neoaortic valve insufficiency in the future following an ASO. In the operative records, an ASO was attempted due to temporal surgical expertise. DORV, Double-outlet right ventricle; VSD, ventricular septal defect; ASD, atrial septal defect: TGA, transposition of the great arteries; TOF, tetralogy of Fallot; PT, pulmonary trunk; RPA, right pulmonary artery; LPA, left pulmonary artery; RVOTO, right ventricular outflow tract obstruction; PA, pulmonary artery.