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Double outlet right ventricle

DORV; Taussig-Bing anomaly; DORV with doubly-committed VSD; DORV with noncommitted VSD; DORV with subaortic VSD; Congenital heart defect - DORV; Cyanotic heart defect - DORV; Birth defect - DORV

 

Double outlet right ventricle (DORV) is a heart disease that is present from birth (congenital). The aorta connects to the right ventricle (RV, the chamber of the heart that pumps oxygen-poor blood to the lungs), instead of to the left ventricle (LV, the chamber that normally pumps oxygen-rich blood to the body).

Both the pulmonary artery (which carries oxygen-poor blood to the lungs) and aorta (which carries oxygen-rich blood from the heart to the body) come from the same pumping chamber. No arteries are connected to the left ventricle (the chamber that normally pumps blood to the body).

Causes

 

In a normal heart structure, the aorta connects to the LV. The pulmonary artery normally is connected to the RV. In DORV, both arteries flow out of the RV. This is a problem because the RV carries oxygen-poor blood. This blood is then circulated throughout the body.

Another defect called a ventricular septal defect (VSD) always occurs with DORV. Other conditions that may be part of the defect are pulmonary valve stenosis and transposition of the great arteries.

Oxygen-rich blood from the lungs flows from the left side of the heart, through the VSD opening and into the RV. This helps the infant with DORV by allowing oxygen-rich blood to mix with oxygen-poor blood. Even with this mixture, the body may not get enough oxygen. This makes the heart work harder to meet the body's needs. There are several types of DORV.

The difference between these types is the location of the VSD as it relates to the location of the pulmonary artery and aorta. The symptoms and severity of the problem will depend on the type of DORV. The presence of pulmonary valve stenosis also affects the condition.

People with DORV often have other heart defects, such as:

  • Endocardial cushion defects (the walls separating all 4 chambers of the heart are poorly formed or absent)
  • Coarctation of the aorta (narrowing of the aorta)
  • Mitral valve problems
  • Pulmonary atresia (pulmonary valve does not form properly)
  • Pulmonary valve stenosis (narrowing of the pulmonary valve)
  • Right-sided aortic arch (aortic arch is on right instead of the left)
  • Transposition of the great arteries (the aorta and pulmonary artery are switched)

 

Symptoms

 

Symptoms of DORV may include:

  • Poor feeding from becoming tired easily
  • Bluish color of the skin and lips
  • Clubbing (thickening of the nail beds) of toes and fingers (late sign)
  • Failure to gain weight and grow
  • Pale coloring
  • Sweating
  • Swollen legs or abdomen
  • Trouble breathing

 

Exams and Tests

 

Signs of DORV may include:

  • Enlarged heart
  • Heart murmur
  • Rapid breathing
  • Rapid heartbeat

Tests to diagnose DORV include:

  • Chest x-rays
  • Ultrasound exam of the heart (echocardiogram)
  • Passing a thin, flexible tube into the heart to measure blood pressure and inject dye for special pictures of the heart and arteries (cardiac catheterization)
  • Heart MRI

 

Treatment

 

Treatment requires surgery to close the hole in the heart and direct blood from the left ventricle into the aorta. Surgery may also be needed to move the pulmonary artery or aorta.

Factors that determine the type and number of operations the baby needs include:

  • The type of DORV
  • The severity of the defect
  • The presence of other problems in the heart
  • The child's overall condition

 

Outlook (Prognosis)

 

How well the baby does depends on:

  • The size and location of the VSD
  • The size of the pumping chambers
  • The location of the aorta and pulmonary artery
  • The presence of other complications (such as coarctation of the aorta and mitral valve problems)
  • The baby's overall health at the time of diagnosis
  • Whether lung damage has occurred from too much blood flowing to the lungs for a long period of time

 

Possible Complications

 

Complications from DORV may include:

  • Heart failure
  • High blood pressure in the lungs, which untreated can lead to permanent lung damage
  • Death

Children with this heart condition may need to take antibiotics before dental treatment. This prevents infections around the heart. Antibiotics may also be needed after surgery.

 

When to Contact a Medical Professional

 

Call your health care provider if your child seems to tire easily, has trouble breathing, or has bluish skin or lips. You should also consult your provider if your baby is not growing or gaining weight.

 

 

References

Kouchoukos NT, Blackstone EH, Hanley FL, Kirklin JK. Double outlet right ventricle. In: Kouchoukos NT, Blackstone EH, Hanley FL, Kirklin JK, eds. Kirklin/Barratt-Boyes Cardiac Surgery. 4th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 53.

Park MK. Cyanotic congenital heart defects. In: Park MK, ed. Park's Pediatric Cardiology for Practitioners. 6th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 14.

Webb GD, Smallhorn JF, Therrien J, Redington AN. Congenital heart disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 62.

 
  • Congenital heart defect overview

    Congenital heart defect overview

    Animation

  •  

    Congenital heart defect overview - Animation

    Facts, causes, and treatment of congenital heart defects.

  • Double outlet right ventricle

    Double outlet right ventricle - illustration

    Double outlet right ventricle (DORV) is a congenital heart disease in which the aorta and pulmonary artery rise from the right ventricle. This configuration allows oxygen-poor blood, to be carried throughout the body. The body is not able to get enough oxygen, causing the heart to work harder to try to bring more oxygen-rich blood to the body.

    Double outlet right ventricle

    illustration

  • Congenital heart defect overview

    Animation

  •  

    Congenital heart defect overview - Animation

    Facts, causes, and treatment of congenital heart defects.

  • Double outlet right ventricle

    Double outlet right ventricle - illustration

    Double outlet right ventricle (DORV) is a congenital heart disease in which the aorta and pulmonary artery rise from the right ventricle. This configuration allows oxygen-poor blood, to be carried throughout the body. The body is not able to get enough oxygen, causing the heart to work harder to try to bring more oxygen-rich blood to the body.

    Double outlet right ventricle

    illustration

A Closer Look

 

    Self Care

     

      Tests for Double outlet right ventricle

       

         

        Review Date: 5/6/2016

        Reviewed By: Scott I. Aydin, MD, Assistant Professor of Pediatrics, Albert Einstein College of Medicine, Division of Pediatric Cardiology and Critical Care Medicine, The Children's Hospital at Montefiore, Bronx, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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