Double-Chambered Right Ventricle Treatment & Management

Updated: Jan 07, 2016
  • Author: Shubhayan Sanatani, MD; Chief Editor: Stuart Berger, MD  more...
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Treatment

Medical Care

Symptoms of double-chambered right ventricle (DCRV) that require therapy are generally an indication for operative repair.

In the presence of a VSD, a significant left to right shunt can be present, requiring antifailure treatment, particularly if the muscle bundles are not sufficiently obstructive to reduce pulmonary blood flow.

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Surgical Care

The first successful surgical repair was reported in 1962. The initial approach was through a ventriculotomy; contemporary series describe both transatrial and transventricular approaches. [8, 9]

Time to intervene naturally depends on the associated lesions; the current practice is to address associated lesions (ventricular septal defect [VSD], subaortic stenosis, pulmonary stenosis) at the time of double-chambered right ventricle repair.

In the absence of a significant associated lesion, observation may be appropriate as long as the intracavitary gradient is not greater than 40 mm Hg and the degree of obstruction is not progressive.

Although attempted, balloon dilatation likely has no role in the management of double-chambered right ventricle. Recently, Tsuchikane et al reported a patient who underwent a percutaneous myocardial ablation with an alcohol-induced conus branch occlusion for relief of a significant pressure gradient in double-chambered right ventricle. [10]

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Activity

Before repair, according to the degree of right ventricular outflow tract obstruction and associated lesions, exercise tolerance may be impaired and cyanosis may be present. After surgical repair and without significant residual anatomic lesions, activity tolerance should be normal.

Guidelines for physical activity and recreational sports participation in children with genetic cardiovascular diseases have previously been established. [11]

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