Home Journal Watch Double outlet of both ventricles: morphological, echocardiographic and surgical considerations

Double outlet of both ventricles: morphological, echocardiographic and surgical considerations

is it possible to buy accutane online European Journal of Cardio-Thoracic Surgery
Volume 59, Issue 3, March 2021, Pages 688–696

bashfully Krishna Subramony Iyer, Ankit Garg, Sumir Girotra, Robert H Anderson, Sushil Azad, Sitaraman Radhakrishnan, Parvathi U Iyer

Abstract

Objectives

Port Stephens To describe the morphology, echocardiographic features and surgical management of the entity appropriately described as ‘double outlet of both ventricles’.

Methods

understandingly Seven patients (5 males, age 0.5–7.5 months) were diagnosed to have a unique form of subarterial ventricular septal defect (VSD) and ventriculo-arterial connection, where a muscular outlet septum straddled the crest of the ventricular septum in a cruciate manner, such that both great arteries were equally committed to both ventricles. Diagnosis was established by echocardiography, with 6 patients submitted to surgical repair by means of intracardiac routing of the left ventricle to the aorta using 2 patches.

Results

Surgical repair was successful in all 6 patients in whom it was attempted. In addition, 1 patient underwent concomitant repair of aortic coarctation, and 2 had closure of multiple VSDs. We lost 1 patient to follow-up after diagnosis. Follow-up with a range from 3 months to 8 years in the remaining patients revealed all to be clinically well with satisfactory growth of both outflow tracts.

Conclusions

We describe a series of patients with the ventriculo-arterial connection best described as ‘double outlet of both ventricles’. Diagnosis is readily established by echocardiography. Good early and midterm results can be expected subsequent to surgical repair using 2 patches for interventricular septation.

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Commentary

The authors describe a unique morphologic presentation of patients with double outlet ventricles such that both great arteries are committed to both ventricles.  In this rare form of ventriculo-arterial connection, the interventricular communication is located such that both arterial roots override the crest of the apical muscular ventricular septum in equal measures. The authors describe the surgical repair of 6 patients with this defect.  Closure of the VSD occurred so that the left ventricle was baffled to the aorta. The authors evolved their technique to use two patches to rout the left ventricle to the Aorta. The defect is similar to the diagnosis of double outlet right ventricle with a large non-committed ventricular septal defect.  I applaud the authors for their innovative technique utilizing two patches to form the intracardiac baffle. This technique should be strongly considered in those complex VSD closures where a single patch will has the potential to distort the tricuspid valve or result in left ventricular outflow tract obstruction.

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