| From your Guide Dr.MANI |  | |
Double Outlet Right Ventricle | ||
| From your Guide Dr.MANI | | |
Double Outlet Right Ventricle | ||
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What factors affect treatment of DORV ?
In addition to the location of the VSD, other factors also affect surgical decision making.
What is the distance between the aorta and the tricuspid valve ?
Surgical repair of DORV involves connecting the left ventricle to the aorta, while leaving the right
ventricle attached to the pulmonary artery. To do this, the surgeon must create a tunnel from the
VSD to the aorta. Blood from the left ventricle will then pass across the VSD into the tunnel, and
finally into the aorta. This is called the Intra-Ventricular Tunnel operation.
There are however certain limitations to this operation. The tunnel will pass through the right
ventricle cavity, between the tricuspid and pulmonary valves. If these two valves are placed very
close together, it will not be possible to create a tunnel of an adequate size without blocking one or
the other of these valves.
The surgeon and cardiologist always decide before operation by tests including echocardiography
about whether this distance is adequate for an intraventricular tunnel operation. If not, other
alternatives must be sought.
What is the size of the VSD ?
The VSD will be a part of the tunnel leading out of the left ventricle. So it must be large enough to
permit blood flow without obstruction. A small VSD may need to be enlarged at the time of
surgery.
Are there any abnormal attachments of the mitral or tricuspid valves ?
The mitral and tricuspid valves are themselves marvels of structural design. They have leaflets
supported by struts - called "chordae tendineae" - attached to muscles called "papillary muscles".
Together this unique system keeps blood flow directed one-way in the normal heart.
Sometimes in DORV, either of these valves may be abnormal. Instead of connecting with one
ventricle, they may over-ride the wall (septum) between the two ventricles. At times, even the
supporting structures - the chordae and papillary muscles - will cross the ventricular septum. This
condition is called "straddling".
Both of these situations are of importance to the surgeon. During the operation, if these structures
are injured or divided, the valve cannot work well, and will become leaky - valve regurgitation. It is
also of great importance to detect valves that are leaky before surgery, since the choice of
operation will vary.
What is the size of the ventricles ?
The reason for requesting this information is to decide if, after repair, the left ventricle will be able to
sustain the future workload of supplying blood to the entire body. Usually, both ventricles are
moderately developed, with the left being much smaller than the right. Sometimes, the left ventricle
may be very small, and then DORV becomes a form of the "Single Ventricle" anomaly.
Is there any other obstruction in the "outlet" arteries ?
Sometimes other abnormalities like coarctation of the aorta or pulmonary artery stenosis may
coexist. If not detected at or before surgery, they can contribute to a poor outcome. These
co-existing anomalies need to be repaired too at the time of surgery.
The feasibility of surgery is never decided on the basis of just one factor, but is based on a
comprehensive evaluation by various tests, including sometimes a catheterization study.
What are the surgical options for DORV ?
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