DCRV PPT Now

SURGICAL OUTCOME AND FOLLOW UP OF
PATIENTS UNDERWENT REPAIR FOR DOUBLE

CHAMBER RIGHT VENTRICLE- INSTITUTIONAL
EXPERIENCE
Dr . Vijayanand Palanisamy M.B.B.S., DNB(CVTS)

Dr .Swaminathan V M.B.B.S., DNB(CVTS)
Dr. Roy varghese M.S., MCh.,
Dr. Ravi agarwal M.S., MCh.,
Dr. Ejaz ahmed sheriff M.S., MCh.,DNB.,
Dr. Anbarasu mohanraj M.S., MCh., DNB.,.
Dr. Rajan sethuratnam M.S., MCh.,
MADRAS MEDICAL MISSION
INTRODUCTION
Double-chambered right ventricle (DCRV) is a
rare congenital anomaly.
Incidence 0.5 to 1.5 %
Stenosis in DCRV is progressive.
Associated with Ventricular septal defect(VSD) in
65% of cases .
Early surgical intervention is recommended for
patients whose symptoms and/or pressure
overload of right ventricle (RV) are progressive .
PATHOPHYSIOLOGY
The presence of anomalous
muscle bundles may produce a
pressure gradient between the
inflow and outflow portions of
the right ventricle . (proximal
high pressure chamber and a
distal low-pressure chamber).
When these patients left
untreated ,they will go for
progressive RV dysfunction
and failure .
CRITERIA TO DIAGNOSIS
ECHO -> absence of infundibular hypoplasia
o CATH ->
a right ventricular angiogram showing a high
or low obstruction by an anomalous muscle bundle
below the infundibulum;
documentation of a systolic pressure gradient
between the inflow of the right ventricle and Right
Ventricular Outflow Tract (RVOT); and
o INTRAOP -> direct observation of
intracardiac muscle bundles during surgical
repair.
o
ECHOCARDIOGRAPHY
aorta
Muscle bundle
infudibulum
ECHOCARDIOGRAPHY
RV outflow
Muscle bundle
RV inflow
Tricuspid valve
CATHETERISATION
PULMONARY
VALVE
INFUNDIBULUM
MUSCLE BUNDLE
In the absence of a moderate or large VSD, the

criteria for the diagnosis of DCRV and the need
for an operation was a systolic pressure gradient
between the inflow and outflow chamber of more
than 50 mm Hg at rest.
AIM
Aim of the study is to analyse the outcome of

surgical repair of Double-Chambered Right
Ventricle in our Institute (MADRAS MEDICAL
MISSION) .
METHODS:
Study area
MMM HOSPITAL(retrospective
observational study )
Study period
2011 to 2014 ( 4 years)
Sample size
23 patients
Follow up period
6 months to 51 months (mean 28 months)
Age of patients
ranges from 1 to 48 years;

mean of 15.8 years
RVOT pressure
51 to 180 mm Hg (mean 95 mm Hg)
gradients
25
20
15
DCRV; 23
10
5
TOTAL; 1143
0
Incidence 1.56%
FEMALE
MALE
ASSOCIATED
CONDITIONS
ANOMALIES
VSD
NO. OF PATIENTS
15(65.2%)
TRICUSPID REGURGITATION
1(4.3%)
ASD
1(4.3%)
ISOLATED DCRV
3(13%)
ASSOCIATED VSD
SUBAORTIC
(5)
PERIMEMB
(9)
OPERATIVE PROCEDURE
All patients underwent surgical correction through a
median sternotomy
Standard cardiopulmonary bypass using aortobicaval cannulation under moderate hypothermia
(28C to 32C).
Hypothermic Del- Nido Cardioplegia
All associated cardiac anomalies were corrected
simultaneously
18
16
14
12
10
8
6
4
2
0
The hypertrophied muscle bundles were excised

to open up the RVOT .
The ventriculotomy was closed with a autologous
pericardial patch
post bypass - Needle pressure checked on table
Trans Esophageal Echo(TEE) to confirm
satisfactory repair
RESULTS:
Parameters
Observation
Follow up
20 out of 23 patients(2-missed out of

follow up , 1 death )
In hospital mortality
1(persistent low cardiac output

syndrome)
Late mortality
Nil
Rhythm
All 20 patients were in sinus

rhythm with 11 patients
associated with RBBB during
follow up
None on pacemaker
PRESSURE GRADIENT OF THE RIGHT VENTRICLE
Axis Title
100
90
80
70
60
50
40
30
20
10
0
(during followup)
DISCUSSION
JOURNALS/AUTHOR
NO. OF
PATIENTS
UNDER
FOLLOW
UP /
OPERATED
MEAN
FOLLOW UP
PERIOD
RESULTS
Peter C. Kahr et al
33/50
8 YEARS
no early or late operative mortality

no patient required re-operation
Masashi Amano et al
29/38
11.0 8.8
years.
no deaths and no surgical reinterventions

no recurrence of DCRV / fatal arrhythmias develop
during the long-term follow-up period
Yoshikazu Hachiro et
al
37/40
16.5 8.9
years
no hospital or late deaths

No patient required further surgery to relieve
obstruction of right ventricular outflow tract.
Xue-jun Mao et al
59/60
1.80.9 years
1 hospital death (1.7%); 59 patients survived (98.3%)

No major symptoms were documented at follow-up
Sameh M. Said et al
59/61
7.4 7.9
years
2 - early deaths due to persistence of low cardiac

output postoperatively.
Late survival was 90% at 10 years.
3 late deaths (heart failure in 2 patients and sudden
death in 1 patient)
No patients required reoperation for residual or
CONCLUSIONS
In conclusion , surgical outcome obtained with
repair of DCRV and related anomalies are
favourable , and neither recurrence of DCRV nor
fatal arrhythmias / death develop during the
follow-up period .
Long term follow up is needed to assess the
recurrence and longevity of repair .
REFERENCE
Sameh M. Said, MD et al ; Outcomes of Surgical Repair of DoubleChambered Right Ventricle ; Ann Thorac Surg 2012;93:197200
Yoshikazu Hachiro, MD et al ; Repair of Double-Chambered Right
Ventricle: Surgical Results and Long-Term Follow-up ; Ann Thorac Surg
2001;72:15202
Peter C. Kahr et al ; Long-term natural history and postoperative outcome
of double-chambered right ventricleExperience from two tertiary adult
congenital heart centres and review of the literature. International
Journal of Cardiology Volume 174, Issue 3, 1 July 2014, Pages 662668
Masashi Amano et al ; Surgical Outcomes and Postoperative Prognosis
Beyond 10 Years for Double-Chambered Right Ventricle . The American
Journal of Cardiology Volume 116, Issue 9, 1 November 2015, Pages 1431
1435
Xue-jun Mao et al ; The diagnosis and surgical treatment of double
chambered right ventricle .
The Asia Pacific Journal of Thoracic & Cardiovascular Surgery
Volume 5, Issue 1, June 1996, Pages 1417
THANK U

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SURGICAL OUTCOME AND FOLLOW UP OF

PATIENTS UNDERWENT REPAIR FOR DOUBLE

Dr . Vijayanand Palanisamy M.B.B.S., DNB(CVTS)

In the absence of a moderate or large VSD, the

Aim of the study is to analyse the outcome of

2011 to 2014 ( 4 years)

6 months to 51 months (mean 28 months)

ranges from 1 to 48 years;

51 to 180 mm Hg (mean 95 mm Hg)

The hypertrophied muscle bundles were excised

20 out of 23 patients(2-missed out of

1(persistent low cardiac output

All 20 patients were in sinus

PRESSURE GRADIENT OF THE RIGHT VENTRICLE

no early or late operative mortality

no deaths and no surgical reinterventions

no hospital or late deaths

1 hospital death (1.7%); 59 patients survived (98.3%)

2 - early deaths due to persistence of low cardiac

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