Two chambered right ventricle. A peculiar intraventricular obstruction

pp 477-482

Abstract

Double chambered rigth ventricle (DCRV) is a form of right ventricular obstruction characterized by muscular narrowing that divided the right ventricle into an inflow and outflow portions. The clinical records of 29 patients with DCRV were reviewed: the age range from 4 months to 63 years and 19 of them were females. The majority of the clinical features were cardiac failures, hypoxemia and exersice intolerance. The diagnosis was confirmed by cardiac catheterization in 22 patients, by two dimensional echocardiogram with color flow Doppler technique in 6, and in the operating room in one. The associated anomalies were: ventricular septal defect (96%); double outlet right ventricle (14%); discrete subaortic stenosis (7%); aortic insufficiency (7%); atrial septal defect (3%), pulmonary valve stenosis (7%) and scimitar syndrome (3%). The mean right intraventricular gradient was 54 mmHg (from 25 to 124). Surgical correction was performed in 21 patients: twelve by ventriculotomy and the others by atrail approach. Two patients were submitted to surgery only with the echocardiogram assistant. Two patients are awaiting surgery and 6 are under clinical revision. Two patients died because meningits and traqueal tube obstruction, other two patients needed reoperation that was succesfuly carried out. A hypertrophic and displaced moderator band, anomalous muscle bundles and obstructive fibromuscular tissue were resected in surgery. All operated patients were in class I between 6 months and 9 years of follow-up- The transatrial surgical approach has advantages over ventriculotomy: optimal view of the morphologic abnormalities, easy closure of the ventricular septal defect and resection of the muscular bands; the additional benefit was the preservation of the right ventricular performance. DCRV is not uncommon form of intraventricular obstruction; when the decision of surgical repair is made a careful echocardiogram color Doppler evaluation may exclude in selected cases the invasive study for the preoperative diagnosis.