Echocardiographic Classification and Surgical Approaches to Double-Outlet Right Ventricle for Great Arteries Arising Almost Exclusively from the Right Ventricle

Abstract

Selecting an appropriate surgical approach for double-outlet right ventricle (DORV),D ouble-outlet right ventricle (DORV) is a complex congenital cardiac malformation, and until recently, it has been difficult to select an appropriate surgical approach for each variation. Regardless of the DORV classification system used, the choice of surgical approach depends on 3 factors: the relative positions of the great arteries, the relationship between the arteries and the ventricular septal defect (VSD), and the presence or absence of right ventricular outflow tract obstruction (RVOTO).The current DORV classification system is based on the international nomenclature databases adopted by the Society of Thoracic Surgeons and the European Association of Cardiothoracic Surgery.1 The system identifies 4 types of DORV, taking into account the types of VSD, tetralogy of Fallot (TOF), transposition of the great arteries (TGA), and remote type. The first 2 types of DORV-the VSD type and the TOF type-have clear surgical options. However, the choice of surgical treatment for DORV with TGA is more difficult because RVOTO may also be present; the current classification system does not adequately account for this possibility. This is especially problematic for patients with a noncommitted VSD and abnormal great arteries because they might need arterial switch operations or double-root translocations. 2To overcome these limitations, we developed an echocardiographic classification system based on the spatial relationships of the great arteries, the relationship of the VSD to the arteries, and the morphology of the RVOT. 3 We then compared our findings with those obtained through cardiac catheterization, computed tomographic (CT) angiography, and intraoperative inspection; monitored the surgical outcomes of patients in the different subgroups; and refined our surgical protocols. Our goal in this study was to evaluate our modified echocardiographic classification system,

Numerical Simulation of the Influence of Geometric Configurations on Pressure Difference in the Intraventricular Tunnel

“…By combining cardiac CT angiography with 3D printing technology, scholars can accurately determine the pathological classification of DORV before surgery. Pathological heart model analysis and simulated surgery can significantly reduce the intraoperative exploration time of DORV with VSD far from the two main arteries (Lefort et al, 2001;Meduri et al, 2007;Garekar et al, 2016;Pang et al, 2017;Wang et al, 2017;Mostefa-Kara et al, 2018).…”

Dupla Via de Saída de Ventrículo Direito com Comunicação Interventricular não Relacionada e Estenose Pulmonar, em Evolução Natural, em Mulher com 36 Anos

“…A técnica corretiva seria muito difícil pela presença de CIV não relacionada e com aorta anterior. 2 Pergunta-se daí, em casos semelhantes na idade infantil, se não seria mais conveniente a tentativa da correção, naquela faixa etária, mesmo com risco cirúrgico também considerável.…”

The variety of phenotypes behind ‘double outlet right ventricle’: clinical and imaging presentations in four dogs and a cat

“…Thus, as illustrated in the present case series, DORV encompasses a wide spectrum of anatomic defects, with a great variability of clinical presentations and pathophysiologic features, including extreme forms mimicking either tetralogy of Fallot or TGA in the case of respectively associated pulmonic stenosis and subpulmonary VSD [6,23]. Various classifications of DORV taking into account these anatomic variations have been proposed in an attempt to standardize surgical approaches in human patients [6,23,24]. One of the most commonly used Beside its above-mentioned extreme anatomic variability, DORV in human patients is also characterized by its common association with multiple cardiac malformations [6,25].…”