Double Outlet Right Ventricle

Surgical Considerations

Hatem Hosny
 Definition
• A heart is termed DORV if >50% of both great arteries arise from the right
ventricle.

• “Double conus” (no aortic-to-mitral continuity) is usual but not necessary.

• Hearts with atrioventricular concordance and two adequate ventricles.

• Taussig–Bing heart: DORV and a subpulmonary VSD

Normal Anatomy
Normal Anatomy
Normal Anatomy
VSD “Types”
VSD “Types”
DORV - VSD “Location ”
Physiology
 Physiology - Presentation
DORV

Doubly- Non-
Sub Aortic Sub Pulm
Committed Committed

No PS PS TGA type VSD type

VSD type Fallot type

DORV, VSD type (Subaortic)
DORV, TOF type
DORV, VSD type (Doubly committed)
DORV, TGA type
DORV, VSD type (non-committed)
Spectrum
 Repair
• Location and size of the VSD.

• Relationship of the great vessels.

• Conal Septum.

• Distance between tricuspid and pulmonary valves.

• RVOT obstruction.

• Coronary anatomy.

• AV valves.

• Aortic arch.
 Management
DORV

Doubly- Non-
Sub Aortic Sub Pulm
Committed Committed

Single
TGA-type
No PS PS Ventricle
repair
Pathway

e.g. VSD Closure

VSD Closure Fallot-type
(LV-PA) +
(LV-Aorta) repair
Arterial Switch
Repair - DORV, Subaortic VSD
Enlarging the VSD
Repair - DORV, Subaortic VSD, PS
Repair - DORV, Subpulmonary VSD
Repair - DORV, Subpulmonary VSD
Repair - DORV, Subpulmonary VSD
Repair - DORV, Subpulmonary VSD, Hypoplastic Arch
Repair - DORV, Subpulmonary VSD
Repair - DORV, non-committed VSD
DORV, Straddling MV
Single Ventricle Pathway
 Management
DORV

Doubly- Non-
Sub Aortic Sub Pulm
Committed Committed

Single
TGA-type
No PS PS Ventricle
repair
Pathway

e.g. VSD Closure

VSD Closure Fallot-type
(LV-PA) +
(LV-Aorta) repair
Arterial Switch