1
|
Early and late outcomes of surgical repair of double-chambered right ventricle: a single-centre experience. Cardiol Young 2020; 30:409-412. [PMID: 32063236 DOI: 10.1017/s1047951120000244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Double-chambered right ventricle is characterised by division of the outlet portion of the right ventricle by hypertrophy of the septoparietal trabeculations into two parts. We aim to report our experiences regarding the presenting symptoms of double-chambered right ventricle, long-term prognosis, including the recurrence rate and incidence of arrhythmias after surgery. METHODS We retrospectively investigated 89 consecutive patients who were diagnosed to have double-chambered right ventricle and underwent a surgical intervention from 1995 to 2016. The data obtained by echocardiography, cardiac catheterisation, and surgical findings as well as post-operative follow-up, surgical approaches, post-operative morbidity, mortality, and cardiac events were evaluated. RESULTS Median age at the time of diagnosis was 2 months and mean age at the time of operation was 5.3 years. Concomitant cardiac anomalies were as follows: perimembranous ventricular septal defect (78 patients), atrial septal defect (9 patients), discrete subaortic membrane (32 patients), right aortic arch (3 patients), aortic valve prolapse and/or mild aortic regurgitation (14 patients), and left superior caval vein (2 patients). The mean follow-up period was 4.86 ± 4.6 years. In these patients, mean systolic pressure gradient in the right ventricle by echocardiography before, immediately, and long-term after surgical intervention was 66.3, 11.8, and 10.4 mmHg, respectively. There were no deaths during the long-term follow-up period. Surgical reinterventions were performed for residual ventricular septal defect (2), residual pulmonary stenosis (1), and severe tricuspid insufficiency (1). CONCLUSION The surgical outcomes and prognosis of double-chambered right ventricle are favourable, recurrence and fatal arrhythmias are unlikely in long-term follow-up.
Collapse
|
2
|
Scurtu I, Tabaran F, Mircean M, Giurgiu G, Nagy A, Catoi C, Ohad DG. Combined double chambered right ventricle, tricuspid valve dysplasia, ventricular septal defect, and subaortic stenosis in a dog. BMC Vet Res 2017; 13:367. [PMID: 29187205 PMCID: PMC5708114 DOI: 10.1186/s12917-017-1275-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 11/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Double chambered right ventricle (DCRV) is a congenital heart anomaly where the right ventricle is divided into two chambers. We describe, for the first time, an unusual combination of DCRV combined with some other congenital heart defects. CASE PRESENTATION A 1.2-year-old Golden Retriever was presented with lethargy, exercise intolerance and ascites. Physical examination revealed an irregularly irregular pulse and a grade V/VI, systolic, right cranial murmur. Electrocardiography revealed widened and splintered QRS complexes with a right bundle-branch block pattern. Radiography demonstrated right-sided cardiomegaly. Two-dimensional echocardiography identified a DCRV with tricuspid valve dysplasia. The patient died despite abdominocentesis and 4 days of oral pharmacotherapy, and necropsy revealed an anomalous fibromuscular structure that divided the right ventricle into two compartments. Another finding was tricuspid valve dysplasia with hypoplasia of the posterior and septal leaflets. The anterior leaflet was prominent, being part of the anomalous structure that divided the right ventricle. Necropsy also identified a perimembranous ventricular septal defect and mild subaortic stenosis. Histopathological examination of the fibromuscular band that separated the right ventricle identified longitudinally oriented layers of dense fibrous connective tissue and myocardial cells arranged in a plexiform pattern. The muscular component was well represented at the ventral area of the fibromuscular band, and was absent in the central zone. Superficially, the endocardium presented areas of nodular hyperplasia covering mainly the fibrous part of the abnormal structure. The nodules were sharply demarcated and were composed by loosely arranged connective tissue with myxoid appearance, covered by discrete hyperplastic endocardium. CONCLUSIONS Concomitant cardiac malformations involving DCRV, tricuspid valve dysplasia, perimembranous ventricular septal defect and mild subaortic stenosis have not been previously described in veterinary medicine, and are reported here for the first time. Moreover, this is the first report of a canine patient with tricuspid valve dysplasia (TVD) and DCRV where the anterior leaflet is part of an anomalous structure dividing the right ventricle (RV) into two separate compartments.
Collapse
Affiliation(s)
- Iuliu Scurtu
- Universitatea de Stiinte Agricole si Medicina Veterinara din Cluj-Napoca, Calea Manastur 3-5, 400372, Cluj-Napoca, Romania
| | - Flaviu Tabaran
- Universitatea de Stiinte Agricole si Medicina Veterinara din Cluj-Napoca, Calea Manastur 3-5, 400372, Cluj-Napoca, Romania.
| | - Mircea Mircean
- Universitatea de Stiinte Agricole si Medicina Veterinara din Cluj-Napoca, Calea Manastur 3-5, 400372, Cluj-Napoca, Romania
| | - Gavril Giurgiu
- Universitatea de Stiinte Agricole si Medicina Veterinara din Cluj-Napoca, Calea Manastur 3-5, 400372, Cluj-Napoca, Romania
| | - Andras Nagy
- Universitatea de Stiinte Agricole si Medicina Veterinara din Cluj-Napoca, Calea Manastur 3-5, 400372, Cluj-Napoca, Romania
| | - Cornel Catoi
- Universitatea de Stiinte Agricole si Medicina Veterinara din Cluj-Napoca, Calea Manastur 3-5, 400372, Cluj-Napoca, Romania
| | - Dan G Ohad
- The Koret School of Veterinary Medicine, Robert H. Smith Faculty of Agriculture Food and Environment, Hebrew University of Jerusalem, P.O. Box 12, 76100, Rehovot, Israel
| |
Collapse
|
3
|
Nagashima M, Tomino T, Satoh H, Nakata T, Ohtani T, Saito H. Double-Chambered Right Ventricle in Adulthood. Asian Cardiovasc Thorac Ann 2016; 13:127-30. [PMID: 15905339 DOI: 10.1177/021849230501300206] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients with double-chambered right ventricle presenting with symptoms in adulthood are rare. From 1990 to 2004, 4 adults and 9 children with double-chambered right ventricle underwent surgical correction. The surgical results and clinical data of the adults were compared with those of the pediatric patients. All adult patients had dyspnea on exertion, 3 children showed growth delay but the others were asymptomatic. The mean age at operation was 44.5 ± 6.3 years in adults and 5.2 ± 1.9 years in children. The mean pressure gradient between the anatomically lower right ventricle and the pulmonary artery was significantly higher in adults than in children (91.8 ± 14.1 vs. 42.2 ± 5.9 mm Hg). The pulmonary-to-systemic flow ratio in adults was significantly lower than in pediatric patients (1.2 ± 0.2 vs. 1.8 ± 0.3). All adults and 8 of the 9 children survived. There were no late deaths or re-operations, and all survivors were in New York Heart Association functional class I. Surgical correction of double-chambered right ventricle in adults gave satisfactory midterm results although right ventricular outflow tract obstruction and clinical symptoms were severe in these patients.
Collapse
Affiliation(s)
- Mitsugi Nagashima
- Department of Cardiovascular Surgery, Ehime Prefectural Central Hospital, Matsuyama city, Ehime, Japan.
| | | | | | | | | | | |
Collapse
|
4
|
Elliott RC, Joubert KE. Surgical correction of a double‐chambered right ventricle under cardiopulmonary bypass. VETERINARY RECORD CASE REPORTS 2016. [DOI: 10.1136/vetreccr-2015-000262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Kenneth Edward Joubert
- Section PharmacologyDepartment of Paraclinical SciencesUniversity of PretoriaPretoriaGautengSouth Africa
| |
Collapse
|
5
|
Amano M, Izumi C, Hayama Y, Onishi N, Tamaki Y, Enomoto S, Miyake M, Tamura T, Kondo H, Kaitani K, Yamanaka K, Nakagawa Y. Surgical Outcomes and Postoperative Prognosis Beyond 10 Years for Double-Chambered Right Ventricle. Am J Cardiol 2015; 116:1431-5. [PMID: 26358511 DOI: 10.1016/j.amjcard.2015.07.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 07/21/2015] [Accepted: 07/21/2015] [Indexed: 11/18/2022]
Abstract
Double-chambered right ventricle (DCRV) is a rare condition. Stenosis of DCRV is progressive, and early surgical intervention is recommended for patients whose symptoms and/or pressure overload of right ventricular (RV) inflow are progressive. However, there are few data regarding the postoperative course of DCRV, and the surgical indications for asymptomatic patients remain to be determined. We retrospectively investigated 38 consecutive patients who were diagnosed with DCRV and underwent surgical intervention from 1981 to 2009. Moreover, we identified 29 patients in whom long-term follow-up transthoracic echocardiographic data were available and investigated the postoperative recurrence of DCRV by evaluating the systolic pressure of RV inflow before, immediately, and in the long term after surgical intervention. The mean follow-up period was 11.0 ± 8.8 years. There were no deaths and no surgical reinterventions during the long-term follow-up period. Among 29 patients with long-term follow-up echocardiographic data, there was no recurrence of DCRV. In these patients, the systolic pressure of RV inflow by echocardiography before, immediately, and long-term after surgical intervention was 80 ± 26, 30 ± 11, and 25 ± 6 mm Hg, respectively. In conclusion, the surgical outcomes and postoperative prognosis beyond 10 years of DCRV are favorable, and neither recurrence of DCRV nor fatal arrhythmias develop during the long-term follow-up period.
Collapse
Affiliation(s)
- Masashi Amano
- Department of Cardiology, Tenri Hospital, Tenri, Japan.
| | - Chisato Izumi
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Yukiko Hayama
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Naoaki Onishi
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Yodo Tamaki
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | | | - Makoto Miyake
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | | | | | | | - Kazuo Yamanaka
- Department of Cardiovascular Surgery, Tenri Hospital, Tenri, Japan
| | | |
Collapse
|
6
|
Long-term natural history and postoperative outcome of double-chambered right ventricle—Experience from two tertiary adult congenital heart centres and review of the literature. Int J Cardiol 2014; 174:662-8. [DOI: 10.1016/j.ijcard.2014.04.177] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/14/2014] [Accepted: 04/17/2014] [Indexed: 11/29/2022]
|
7
|
Said SM, Burkhart HM, Dearani JA, O'Leary PW, Ammash NM, Schaff HV. Outcomes of surgical repair of double-chambered right ventricle. Ann Thorac Surg 2012; 93:197-200. [PMID: 22093693 DOI: 10.1016/j.athoracsur.2011.08.043] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 08/14/2011] [Accepted: 08/17/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND We reviewed our experience with surgical repair of double-chambered right ventricle and long-term outcome. METHODS From November 1970 to February 2008, repair of double-chambered right ventricle was performed in 61 patients (31 males). The median age was 13 years (interquartile range, 2 months to 64 years); 10 patients were infants (16%). Mean preoperative right ventricular outflow tract pressure gradient was 67±37 mm Hg. An associated ventricular septal defect was present in 50 patients (82%). RESULTS There were 2 (3%) early deaths due to persistence of low cardiac output postoperatively, despite complete relief of the right ventricular gradient. The overall mean postoperative gradient was 2±4.5 mm Hg. Late follow-up was complete in 92% (mean, 7.4±7.9 years; maximum, 37 years). Late survival was 90% at 10 years. There were 3 late deaths due to heart failure in 2 patients and sudden death in 1 patient, all occurring before 1997. No patients required reoperation for residual or recurrent right ventricular obstruction. CONCLUSIONS Surgical correction of double-chambered right ventricle results in excellent functional and hemodynamic long-term results, with complete relief of the right ventricular obstruction. The presence of a double-chambered right ventricle should be considered in anomalies with high or persistent right ventricular outflow tract obstruction.
Collapse
Affiliation(s)
- Sameh M Said
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | | |
Collapse
|
8
|
Kottayil BP, Dharan BS, Pillai VV, Panicker VT, Gopalakrishnan SK, Jayakumar K. Surgical repair of double-chambered right ventricle in adulthood. Asian Cardiovasc Thorac Ann 2011; 19:57-60. [DOI: 10.1177/0218492310395955] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate a rare subset of adult patients with double-chambered right ventricle, pertaining to clinical presentation, rhythm disturbances, surgical approach, and results of surgical repair. A retrospective review of our records revealed that 14 adults had undergone surgical repair of double-chambered right ventricle from 1990 to 2010. Their median age was 25.5 years, and their median weight was 50 kg. Patients presented with various symptoms, the most common being dyspnea on exertion. The mean systolic pressure gradient across the obstruction was 69.8 ± 23.1 mm Hg. The most common associated anomaly was ventricular septal defect. Significant rhythm disturbances were present in 4 patients. Transatrial repair was undertaken in 5 patients, a combined transatrial and transpulmonary approach was used in 4, and a right ventriculotomy in 5. There was no mortality at a median follow-up of 5.1 years. A mild right ventricular outflow tract gradient was noted in 2 patients. Medical management was required for rhythm disturbances in 2 patients. Double-chambered right ventricle can present in adulthood, often with vague symptoms. The midterm results of surgical correction are satisfactory. Long-term follow-up is necessary to detect late arrhythmias.
Collapse
Affiliation(s)
- Brijesh P Kottayil
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, India
| | - Baiju S Dharan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, India
| | - Vivek V Pillai
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, India
| | - Varghese T Panicker
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, India
| | - Shyamkrishnan K Gopalakrishnan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, India
| | - Karunakaran Jayakumar
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, India
| |
Collapse
|
9
|
Gadhinglajkar SV, Sreedhar R, Chandranmahaldar DA, Minhaj MM, Tempe DK. Case 2-2010 combined surgery for coronary artery disease, mitral stenosis, and double-chamber right ventricle. J Cardiothorac Vasc Anesth 2010; 24:356-63. [PMID: 20362239 DOI: 10.1053/j.jvca.2010.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Indexed: 11/11/2022]
|
10
|
Truong QA, Yared K, Maurovich-Horvat P, Siegel E, Cubeddu RJ, King ME, Heist EK, Mansour M, Holmvang G. Images in cardiovascular medicine. Double-chambered right ventricle and situs inversus with dextrocardia. Circulation 2010; 121:e229-32. [PMID: 20212287 DOI: 10.1161/cir.0b013e3181d56ebd] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Quynh A Truong
- Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Initial clinical manifestations and mid- and long-term results after surgical repair of double-chambered right ventricle in children and adults. Cardiol Young 2008; 18:268-74. [PMID: 18312713 DOI: 10.1017/s1047951108001984] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE By means of retrospective analysis of our institutional experience, we reviewed the clinical manifestation and outcomes of patients subsequent to surgical repair of double-chambered right ventricle. METHODS Between 1988 and 2005, we performed surgical repair in 35 of 37 patients diagnosed with double-chambered right ventricle. The patients ranged in age from 4 to 69 years, with a mean of 21.3 years. Most presented in infancy, with initial manifestation of a short systolic murmur in 34 (92%) of all cases. Pressure gradients were measured invasively across the right ventricular outflow tract of between 30 and 140 mmHg, with a median of 60 mmHg. An associated ventricular septal defect was present in 26 patients (70%). Of the group, 4 patients were aged over 40 years, and 2 had previously undergone operative closure of a ventricular septal defect. RESULTS The operative interval ranged from 2 months to 41 years, with a median of 9 years. In all, we resected muscular bundles and enlarged the right ventricular outflow tract. There was no hospital or late death. Median follow-up subsequent to surgery was 7 years, with a range from 0.4 to 11 years. No patient required further surgery to relieve any obstruction of the right ventricular outflow tract, nor long term medical therapy or pacing because of cardiac arrhythmia. CONCLUSIONS Surgical repair of a double-chambered right ventricle yields excellent haemodynamic and functional results over the mid to long term.
Collapse
|
12
|
Puvaneswary M, Indira N, Sreedhar M, Barooah B. Double-chambered right ventricle: magnetic resonance imaging findings. AUSTRALASIAN RADIOLOGY 2005; 49:170-4. [PMID: 15845060 DOI: 10.1111/j.1440-1673.2005.01368.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Primary double-chambered right ventricle is an uncommon congenital anomaly that presents with right ventricular outflow tract obstruction in childhood or adolescence. A search of the literature revealed only a few documented case reports with MRI findings. We present a case with mixed lesions, and with anomalous muscle bundles located both in the middle portion of the right ventricular sinus and at the subinfundibular level.
Collapse
Affiliation(s)
- M Puvaneswary
- Department of Medical Imaging, John Hunter Hospital, Newcastle, New South Wales, Australia.
| | | | | | | |
Collapse
|
13
|
Oliver JM, Garrido A, González A, Benito F, Mateos M, Aroca A, Sanz E. Rapid progression of midventricular obstruction in adults with double-chambered right ventricle. J Thorac Cardiovasc Surg 2003; 126:711-7. [PMID: 14502143 DOI: 10.1016/s0022-5223(03)00044-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the rate of progression of midventricular obstruction in adolescents and adults with double-chambered right ventricle. METHODS Clinical and echocardiographic findings in 45 patients (mean age 26 +/- 6 years, range 15-44) diagnosed with double-chambered right ventricle were retrospectively analyzed. Twenty patients underwent surgical repair before the age of 15 years. The relationship between Doppler midventricular pressure gradient and patient age was analyzed in 25 patients without previous repair. Sequential change in midventricular obstruction was determined for patients with 2 or more Doppler echocardiographic examinations performed within at least a 2-year interval. RESULTS Right midventricular pressure gradient in nonrepaired patients was 70 +/- 38 mm Hg (range 25-150). A significant relationship between midventricular obstruction and patient age (r = 0.64, P <.001) was found. Midventricular pressure gradient at initial evaluation was 32 +/- 27 mm Hg in 16 patients < 25 years and 73 +/- 45 mm Hg in 9 patients >/= 25 years (P <.03). After the initial study, 5 patients underwent surgical repair and 13 patients without repair were followed up for a period of 6.1 +/- 2.7 years (range 2-9), in which midventricular pressure gradient increased from 32 +/- 26 mm Hg to 67 +/- 35 mm Hg (P <.001). The slope of the change in midventricular pressure gradient was 6.2 +/- 3 mm Hg per year of follow-up. Seven more patients underwent surgical repair during follow-up due to progression of the obstruction. There was no mortality nor residual midventricular obstruction in surgically repaired patients. CONCLUSIONS Mild right midventricular obstruction shows a fast rate of progression in adolescents and young adults. Thus, close clinical and echocardiographic follow-up is advised, and surgical repair should be considered if significant progression of obstruction is detected.
Collapse
Affiliation(s)
- José María Oliver
- Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, La Castellana 261, Madrid 28046, Spain.
| | | | | | | | | | | | | |
Collapse
|
14
|
MacLean HN, Abbott JA, Pyle RL. Balloon Dilation of Double-Chambered Right Ventricle in a Cat. J Vet Intern Med 2002. [DOI: 10.1111/j.1939-1676.2002.tb01268.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
15
|
Alva C, Ortegón J, Herrera F, Meléndez C, David F, Jiménez S, Jiménez D, Sánchez A, Hernández M, Ledesma M, Argüero R. Types of obstructions in double-chambered right ventricle: mid-term results. Arch Med Res 2002; 33:261-4. [PMID: 12031631 DOI: 10.1016/s0188-4409(02)00354-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The double-chambered right ventricle (DCRV) is increasingly recognized as a distinct obstruction entity. The nature of the obstruction is not well defined. METHODS Patients with DCRV were prospectively studied during the last 4 years according to the following criteria: 1) pressure gradient by echo Doppler and cardiac catheterization within the right ventricle; 2) angiographic demonstration, and 3) surgical confirmation. RESULTS From March 1997 to March 2001, 10 new cases were included. Age ranged from 2 to 14 years (mean 9.5 +/- 4.4 years), weight ranged from 9.9 to 75 kg (mean 23 +/- 13.6 kg), and height from 0.85 to 1.48 m (mean 114 +/- 19 cm). Systolic gradient by echo Doppler ranged from 20 to 135 mmHg (mean 86 +/- 44 mmHg) and by cardiac catheterization, 18 to 130 mmHg (mean 78 +/- 35 mmHg). In terms of angiographic findings, in six patients the right ventriculogram showed an oblique and low obstruction; in four patients the obstruction was high and horizontal. With regard to surgical findings, angiographic findings were confirmed by the surgeon except in one patient, in whom both types of obstruction were present. No mortality was observed. With follow-up 4 to 40 months after surgery (mean 24 +/- 15 months), 8 of 10 patients were evaluated; all corresponded to class I NYHA. Systolic gradient by echo Doppler ranged from 0 to 11 mmHg (mean 4 +/- 6 mmHg). CONCLUSIONS DCRV IS PRODUCED BY THE FOLLOWING THREE TYPES OF MUSCULAR OBSTRUCTIONS: low and oblique obstruction; high and horizontal obstruction, and mixed obstruction. Mid-term surgical results are satisfactory.
Collapse
Affiliation(s)
- Carlos Alva
- Departamento de Enfermedades Congénitas del Corazón, Hospital de Cardiología, Centro Médico Nacional Siglo XXI (CMN-SXXI), Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Martin JM, Orton EC, Boon JA, Mama KR, Gaynor JS, Bright JM. Surgical correction of double-chambered right ventricle in dogs. J Am Vet Med Assoc 2002; 220:770-4, 768. [PMID: 11918270 DOI: 10.2460/javma.2002.220.770] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Double-chambered right ventricle (DCRV) is possibly an emerging congenital cardiac anomaly in dogs. The defect causes clinical and pathophysiologic signs similar to those of congenital pulmonic stenosis in dogs but has distinct diagnostic features, breed predilections, and implications for treatment. The defect is often associated with clinical signs early in life. Surgical correction of DCRV can be undertaken with the aid of cardiopulmonary bypass and offers the prospect of an improved clinical outcome.
Collapse
Affiliation(s)
- Julie M Martin
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Ft. Collins 80523, USA
| | | | | | | | | | | |
Collapse
|
17
|
Hachiro Y, Takagi N, Koyanagi T, Morikawa M, Abe T. Repair of double-chambered right ventricle: surgical results and long-term follow-up. Ann Thorac Surg 2001; 72:1520-2. [PMID: 11722036 DOI: 10.1016/s0003-4975(01)02982-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND We reviewed the outcomes of double-chambered right ventricle repair. METHODS Between 1969 and 1998, 40 patients underwent surgical repair of a double-chamber right ventricle. The patients ranged in age from 3 months to 52 years (mean, 12.8 +/- 11.6 years). Right ventricular outflow tract pressure gradients were from 20 to 170 mm Hg (mean, 65.0 +/- 38.5 mm Hg) An associated ventricular septal defect was present in 27 patients (67.5%). Four patients were older than 30 years of age. RESULTS There were no hospital or late deaths. Mean postsurgical follow-up was 16.5 +/- 8.9 years (range, 2.5 to 31 years). No patient required further surgery to relieve obstruction of right ventricular outflow tract. CONCLUSIONS Surgical repair of a double-chambered right ventricle yields excellent hemodynamic and functional results over both the short and long term.
Collapse
Affiliation(s)
- Y Hachiro
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Japan.
| | | | | | | | | |
Collapse
|
18
|
Affiliation(s)
- R P Scott
- Department of Surgery, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA.
| |
Collapse
|
19
|
Lacour-Gayet F. Congenital Heart Surgery Nomenclature and Database Project: right ventricular outflow tract obstruction-intact ventricular septum. Ann Thorac Surg 2000; 69:S83-96. [PMID: 10798420 DOI: 10.1016/s0003-4975(99)01240-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The extant nomenclature for pulmonary atresia/stenosis with intact ventricular septum, pulmonary artery and/or pulmonary branch stenosis, double chambered right ventricle, absent pulmonary valve with intact ventricular septum, and ventricular to pulmonary artery conduit failure is reviewed for the purpose of establishing a unified reporting system. The subject was debated and reviewed by members of the STS-Congenital Heart Surgery Database Committee and representatives from the European Association for Cardiothoracic Surgery. All efforts were made to include all relevant nomenclature categories using synonyms where appropriate. Multiple risk factors were considered such as coronary artery fistulas/sinusoids, tricuspid annular size and location of peripheral pulmonary artery stenoses. A comprehensive database set is presented which is based on a hierarchical scheme. Data are entered at various levels of complexity and detail which can be determined by the clinician. These data can lay the foundation for comprehensive risk stratification analyses. A minimum database set is also presented which will allow for data sharing and would lend itself to basic interpretation of trends. Potential diagnostic related risk factors for each lesion are presented.
Collapse
|
20
|
Tsuchikane E, Kobayashi T, Kirino M, Nakaoka Y, Otsuji S, Tateyama H, Takami H, Sakurai M, Awata N. Percutaneous myocardial ablation in double-chamber right ventricle. Catheter Cardiovasc Interv 2000; 49:97-101. [PMID: 10627379 DOI: 10.1002/(sici)1522-726x(200001)49:1<97::aid-ccd23>3.0.co;2-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Double-chamber right ventricle (DCRV) exhibits intracavitary outflow obstruction. We report the first case of percutaneous myocardial ablation of DCRV in a 73-year-old patient. An alcohol-induced conus branch occlusion provided the reduction of pressure gradient from 81 to 48 mm Hg and clinical improvement. This strategy may be an alternative therapy to surgery in the adult patients with DCRV. Cathet. Cardiovasc. Intervent. 49:97-101, 2000.
Collapse
Affiliation(s)
- E Tsuchikane
- Department of Cardiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Alva C, Ho SY, Lincoln CR, Rigby ML, Wright A, Anderson RH. The nature of the obstructive muscular bundles in double-chambered right ventricle. J Thorac Cardiovasc Surg 1999; 117:1180-9. [PMID: 10343270 DOI: 10.1016/s0022-5223(99)70258-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Our goal was to establish the morphologic nature of the obstructive muscular lesions in double-chambered right ventricle. METHODS We based our morphologic observations on 10 normal hearts and on the surgical findings in 26 patients, aged 0.5 to 24 years, with a mean of 6.9 years (SD 5.8 years). In the normal hearts, we measured the distance from the pulmonary valve to the apex of the right ventricle and from the takeoff of the moderator band to the ventricular apex. From angiograms available in 20 patients, using the frontal view, we then measured the distance from the pulmonary valve to the apex of the right ventricle and from the midpoint of the obstructive lesion to the apex of the right ventricle. This permitted calculations of multiple ratios. RESULTS In the 10 normal hearts, the moderator band took origin at a mean ratio of 0.48 (SD 0.16) of the ventricular length. On the basis of the angiographic findings, we identified 2 basic forms of double-chambered right ventricle. In 9 patients, the obstructive muscular shelf was positioned low and diagonally across the apical component, with a mean ratio of 0.38 relative to the ventricular length (SD 0.02). In the other 11 patients, the obstructive shelf was high and horizontal, with a mean ratio of 0.27 (SD 0.02). The difference was statistically significant (P =.001). Surgical repair was performed successfully in all 26 patients through a right ventriculotomy. CONCLUSIONS Double-chambered right ventricle is the consequence of a high or low muscular division of the apical component of the right ventricle. The abnormal muscular bundle probably represents accentuated septoparietal trabeculations, rather than always being an abnormal moderator band.
Collapse
Affiliation(s)
- C Alva
- Paediatrics, National Heart and Lung Institute, Royal Brompton Campus, Imperial College School of Medicine, London, United Kingdom
| | | | | | | | | | | |
Collapse
|
22
|
Shuke N, Sugiki K, Ajiki H, Honma H, Yoshida N, Aburano T, Ohno T. Demonstration of double-chambered right ventricle on myocardial perfusion SPECT. Clin Nucl Med 1998; 23:223-5. [PMID: 9554193 DOI: 10.1097/00003072-199804000-00006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A 19-year-old man with a double-chambered right ventricle (DCRV) and an associated ventricular septal defect was admitted to the hospital for surgical correction. Preoperative study of myocardial perfusion with Tc-99m tetrofosmin SPECT depicted the two chambers of the right ventricle. There was a substantial differential in the radioactive uptake between these two chambers. The inflow and outflow chambers with different peak-pressures (94 and 18 mm Hg) showed different uptakes reflecting the pressure difference, which was intense in the inflow chamber and weak in the outflow.
Collapse
Affiliation(s)
- N Shuke
- Department of Radiology, Asahikawa Medical College, Japan
| | | | | | | | | | | | | |
Collapse
|
23
|
Shuler CO, Wienecke MM, Fyfe DA. Color flow Doppler in the diagnosis of double-chambered right ventricle: a demographic and echocardiographic study. Echocardiography 1994; 11:173-8. [PMID: 10146719 DOI: 10.1111/j.1540-8175.1994.tb01063.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
UNLABELLED The purpose of this study was to evaluate the demographic and echocardiographic data of patients diagnosed with double-chambered right ventricle and attempt to explain a perceived rise in the incidence. DEFINITION Double-chambered right ventricle (DCRV) is a division of the right ventricle into two chambers by a hypertrophied muscle bundle. METHODS The medical records of patients diagnosed with DCRV were reviewed, and demographic, echocardiographic, and catheterization data were tabulated. Annual incidence of DCRV, based on year of birth, was compared to yearly detection rate, based on year of DCRV diagnosis. To evaluate the influence of color flow Doppler on the frequency of diagnosis of DCRV, demographics of patients born prior to September 1986 (when utilization of color Doppler began in our institution) were compared to those born after that date. RESULTS Despite an unchanged annual incidence of DCRV, yearly detection rate of this lesion rose significantly following the introduction of color flow Doppler to our institution (September 1986). DCRV was diagnosed earlier and was accompanied by earlier catheterization, which also showed lower right ventricular body gradients after September 1986. Associated anomalies, both cardiac and noncardiac, in our population differed from those reported in previous series. CONCLUSION This study infers that the advent of color flow Doppler significantly enhanced the diagnosis of DCRV in our pediatric patients and led to a perceived rise in incidence.
Collapse
Affiliation(s)
- C O Shuler
- South Carolina Children's Heart Center, Medical University of South Carolina, Charleston 29425
| | | | | |
Collapse
|
24
|
Ford DK, Bullaboy CA, Derkac WM, Hopkins RA, Jennings RB, Johnson DH. Transatrial repair of double-chambered right ventricle. Ann Thorac Surg 1988; 46:412-5. [PMID: 3178350 DOI: 10.1016/s0003-4975(10)64654-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Double-chambered right ventricles (DCRVCs) traditionally have been repaired via a right ventriculotomy. We describe the cases of 8 children (aged 7 months to 6 years; weight, 6.3 to 21.5 kg), who underwent repair of DCRV via a right atriotomy. Six patients had ventricular septal defects. Peak systolic gradients in the right ventricular outflow tract were 26 to 135 mm Hg. The QP/QS were 1.1 to 2.5. Cardiopulmonary bypass times were 52 to 89 min (mean, 65.5 min) with aortic cross-clamp times of 20 to 56 min (mean, 39 min). Mean intraoperative gradients following repair were 5.8 mm Hg. Three patients had transient postoperative atrioventricular block requiring temporary pacing. Two patients required minimal inotropic support (dopamine, 2.5 to 5 micrograms/kg/min). The children have all been asymptomatic after hospitalization with follow-up times of 5 months to 4.5 years. No patient requires cardiac medications or has significant, persistent dysrhythmias; however, 1 patient required reoperation. Transatrial repair of DCRV allows excellent operative anatomical visualization and should be considered as an alternative to the transventricular approach in patients with this congenital heart defect.
Collapse
Affiliation(s)
- D K Ford
- Division of Pediatric Cardiology, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk 23507
| | | | | | | | | | | |
Collapse
|