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Maggo K, Bhayana A, Gupta P, Gupta V, Verma A, Malik A. Double trouble - dual outflow tract obstruction in congenital heart disease: a case report. BMC Cardiovasc Disord 2024; 24:188. [PMID: 38561658 PMCID: PMC10986126 DOI: 10.1186/s12872-024-03842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Double chambered right ventricle is a rare congenital heart disease that is characterised by the presence of an anomalous muscle bundle that divides the right ventricle into a low pressure superior (distal) chamber and a high pressure inferior (proximal) chamber. It is found in association with a ventricular septal defect in 90% cases with other associations being tetralogy of Fallot, transposition of great vessels, atrial septal defect and Ebstein's anomaly. On the other hand, subaortic membrane is a form of discrete subaortic stenosis that is characterised by a membranous diaphragm in the subvalvular location of the left ventricular outflow tract. Both of these entities are responsible for causing subvalvular outflow tract obstruction. The occurrence of double chambered right ventricle in association with subaortic membrane is an extremely rare entity with only a few case reports available in the literature. CASE REPORT A 13-year-old male child with history of chest pain and palpitations presented to the outpatient department of a tertiary care center. Transthoracic echocardiography revealed a subaortic membrane producing a pressure gradient across the left ventricular outflow tract with dilatation of the right atrium and right ventricle which could not be fully evaluated on echocardiography. Cardiac computed tomography was then performed which additionally revealed an anomalous muscle bundle coursing across the right ventricle from the septum to the subinfundibular region creating a double chambered right ventricle. The patient was then taken up for reconstruction of right ventricular outflow tract and resection of subaortic membrane. CONCLUSION Right and left outflow tract obstructions are rare congenital lesions which when seen in combination, become even more infrequent. Echocardiography is a robust tool that detects turbulent flow to identify such lesions. However, poor acoustic window may sometimes result in missing these lesions and computed tomography in such situations can play an important role in detection as well as complete preoperative imaging evaluation.
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Affiliation(s)
- Kanchan Maggo
- Department of Radiology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Aanchal Bhayana
- Department of Radiology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Pranav Gupta
- Department of Radiology, GB Pant Hospital (GIPMER), New Delhi, India.
| | - Vidushi Gupta
- Department of Radiology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Animesh Verma
- Department of Radiology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Amita Malik
- Department of Radiology, VMMC and Safdarjung Hospital, New Delhi, India
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Malone RJ, Henderson ER, Wilson ZR, McMullan MR, Skelton TN, Campbell WF, McMullan MR. Double-Chambered Right Ventricle in Adulthood: A Case Series. CASE (PHILADELPHIA, PA.) 2024; 8:202-209. [PMID: 38524987 PMCID: PMC10954581 DOI: 10.1016/j.case.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•DCRV is a rare cardiac anomaly leading to subvalvular RVOT obstruction. •DCRV is most frequently found in children but can occur in adults. •Adults with DCRV are often initially misdiagnosed. •Echocardiography is the first-line imaging modality to visualize this anomaly. •Providers should be aware of this condition and the associated image findings.
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Affiliation(s)
| | | | - Zachary Ryan Wilson
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Matthew R. McMullan
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Thomas N. Skelton
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
- Division of Cardiovascular Disease, University of Mississippi Medical Center, Jackson, Mississippi
| | - William F. Campbell
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
- Division of Cardiovascular Disease, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michael R. McMullan
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
- Division of Cardiovascular Disease, University of Mississippi Medical Center, Jackson, Mississippi
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Jayaprasad N, Madhavan S. Double-chambered right ventricle in a patient with pulmonary atresia and ventricular septal defect. BMJ Case Rep 2024; 17:e257480. [PMID: 38359952 PMCID: PMC10875559 DOI: 10.1136/bcr-2023-257480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Double-chambered right ventricle is a rare form of right ventricular outflow tract obstruction caused by anomalous hypertrophy of muscle bundles in right ventricle. Cases most often occur in children and rarely in adults. Most cases (80-90%) are associated with ventricular septal defect. We describe a case of pulmonary atresia and ventricular septal defect with double-chambered right ventricle. The interesting clinical findings, ECG, echocardiography and angiocardiography features are described here.
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Affiliation(s)
| | - Suresh Madhavan
- Cardiology, Goverment Medical College, Kottayam, Kerala, India
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Sharma A, Chera HH, Agarwal S, Michelakis N, Gubernikoff G, Gopal AS. Double Chamber Right Ventricle with New-Onset Biventricular Failure in an Octogenarian. CASE 2022; 6:178-182. [PMID: 35818489 PMCID: PMC9270667 DOI: 10.1016/j.case.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Akanksha Sharma
- Department of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Habib Hymie Chera
- Department of Cardiology, NYU Long Island School of Medicine, Mineola, New York
| | - Siddharth Agarwal
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - George Gubernikoff
- Department of Cardiology, NYU Long Island School of Medicine, Mineola, New York
| | - Aasha S. Gopal
- Department of Cardiology, NYU Long Island School of Medicine, Mineola, New York
- Correspondence: Aasha S. Gopal, MS, MD, Clinical Associate Professor of Medicine, NYU Langone Cardiology Associates–Mineola, 212 Jericho Turnpike, 2nd Floor, Mineola, New York 11501.
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Papakonstantinou NA, Kanakis MA, Bobos D, Giannopoulos NM. Congenital, acquired, or both? The only two congenitally based, acquired heart diseases. J Card Surg 2021; 36:2850-2856. [PMID: 33908651 DOI: 10.1111/jocs.15588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 11/28/2022]
Abstract
Discrete subaortic stenosis (DSS) is a type of left ventricular outflow tract obstruction whereas double-chambered right ventricle is a form of right ventricular outflow tract obstruction. Both of these cardiac malformations share lots of similar characteristics which classify them as acquired developmental heart diseases despite their congenital anatomical substrate. Both of them are frequently associated to ventricular septal defects. The initial stimulus in their pathogenetic process is anatomical abnormalities or variations. Subsequently, a hemodynamic process is triggered finally leading to an abnormal subaortic fibroproliferative process with regard to DSS or to hypertrophy of ectopic muscles as far as double-chambered right ventricle is concerned. In many cases, these pathologies are developed secondarily to surgical management of other congenital or acquired heart defects. Moreover, high recurrence rates after initial successful surgical therapy, particularly regarding DSS, have been described. Finally, an interesting coexistence of DSS and double-chambered aortic ventricle has also been reported in some cases.
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Affiliation(s)
| | - Meletios A Kanakis
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Dimitrios Bobos
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Nicholas M Giannopoulos
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, Athens, Greece
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Garg A, Agrawal D, Sharma GL. Isolated Double-Chambered Right Ventricle - A Rare Entity. J Cardiovasc Echogr 2020; 30:162-164. [PMID: 33447507 PMCID: PMC7799069 DOI: 10.4103/jcecho.jcecho_36_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/30/2020] [Accepted: 09/02/2020] [Indexed: 11/24/2022] Open
Abstract
A double-chambered right ventricle (DCRV) is a rare congenital heart disease and an uncommon cause of congestive heart failure. An anomalous muscle band divides the right ventricle into two cavities: the proximal high-pressure chamber and the distal low-pressure chamber. Most cases are diagnosed and treated during childhood. Furthermore, there is a tendency for progression, if not treated early. Echocardiography is considered useful for the diagnosis of this ailment. Most of the patients have associated congenital anomalies, such as ventricular septal defect, pulmonary stenosis, and subaortic stenosis. Isolated DCRV is a rare entity. Hence, we report a case of an isolated DCRV in an adult patient.
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Affiliation(s)
- Ashok Garg
- Department of Preventive and Noninvasive Cardiology, Jaipur Heart Institute, Jaipur, Rajasthan, India
| | - Deepak Agrawal
- Department of Cardiology, Jaipur Heart Institute, Jaipur, Rajasthan, India
| | - G L Sharma
- Department of Cardiology, Jaipur Heart Institute, Jaipur, Rajasthan, India
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Rajiah P, MacNamara J, Chaturvedi A, Ashwath R, Fulton NL, Goerne H. Bands in the Heart: Multimodality Imaging Review. Radiographics 2019; 39:1238-1263. [DOI: 10.1148/rg.2019180176] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Baxi AJ, Tavakoli S, Vargas D, Restrepo CS. Bands, Chords, Tendons, and Membranes in the Heart: An Imaging Overview. Curr Probl Diagn Radiol 2015; 45:380-391. [PMID: 26433812 DOI: 10.1067/j.cpradiol.2015.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 08/24/2015] [Indexed: 11/22/2022]
Abstract
Crests, bands, chords, and membranes can be seen within the different cardiac chambers, with variable clinical significance. They can be incidental or can have clinical implications by causing hemodynamic disturbance. It is crucial to know the morphology and orientation of normal structures, aberrant or accessory muscles, and abnormal membranes to diagnose the hemodynamic disturbance associated with them. Newer generation computed tomographic scanners and faster magnetic resonance imaging sequences offer high spatial and temporal resolution allowing for acquisition of high resolution images of the cardiac chambers improving identification of small internal structures, such as papillary muscles, muscular bands, chords, and membranes. They also help in identification of other associated complications, malformations, and provide a road map for treatment. In this article, we review cross-sectional cardiac imaging findings of normal anatomical variants and distinctive imaging features of pathologic bands, chords, or membranes, which may produce significant hemodynamic changes and clinical symptomatology.
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Affiliation(s)
- Ameya Jagdish Baxi
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
| | - Sina Tavakoli
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Daniel Vargas
- Department of Radiology, University of Colorado Hospital, Denver, CO
| | - Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
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Loukas M, Housman B, Blaak C, Kralovic S, Tubbs RS, Anderson RH. Double-chambered right ventricle: a review. Cardiovasc Pathol 2013; 22:417-23. [PMID: 23701985 DOI: 10.1016/j.carpath.2013.03.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 03/16/2013] [Accepted: 03/18/2013] [Indexed: 11/19/2022] Open
Abstract
A double-chambered right ventricle is a rare heart defect in which the right ventricle is separated into a high-pressure proximal and low-pressure distal chamber. This defect is considered to be congenital and typically presents in infancy or childhood but has been reported to present rarely in adults. It can be caused by the presence of anomalous muscle tissue, hypertrophy of the endogenous trabecular bands, or an aberrant moderator band; all of which will typically result in progressive obstruction of the outflow tract. In this paper, we will discuss the general anatomy of the right ventricle, the relevant embryology of the heart, and the presentation, diagnosis, and treatment of a double-chambered right ventricle.
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Affiliation(s)
- Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St George's University, Grenada, West Indies.
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