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

Eur J Cardiothorac Surg. 2021 Apr 13;59(3):688-696. doi: 10.1093/ejcts/ezaa378.

Abstract

Objectives: To describe the morphology, echocardiographic features and surgical management of the entity appropriately described as 'double outlet of both ventricles'.

Methods: 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.

Keywords: Double outlet of both ventricles; Intracardiac rerouting; Two-patch septation.

MeSH terms

  • Aorta
  • Double Outlet Right Ventricle* / diagnostic imaging
  • Double Outlet Right Ventricle* / surgery
  • Echocardiography
  • Heart Septal Defects, Ventricular* / diagnostic imaging
  • Heart Septal Defects, Ventricular* / surgery
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / surgery
  • Humans
  • Infant
  • Infant, Newborn
  • Male