Double outlet of right ventricle: imaging spectrum on multi-slice computed tomography

Yashpal R. Rana, Dinesh L. Patel, Megha M. Sheth, Nitisha A. Jain, Samir G. Patel, Milin N. Garachh


Background: Multi-slice computed tomography (MSCT) is the main stay of pre-operative assessment of many complex congenital heart diseases (CHD) in current clinical practice, one of them is double outlet of right ventricle (DORV). DORV is one of the conotruncal anomalies that encompasses a wide spectrum of anatomic malformations in which both the aorta and pulmonary arterial trunk arise entirely or predominantly from the morphologically right ventricle (RV). Purpose of this article is to understand spectrum of DORV and associated types of ventricular septal defect (VSD) on MSCT imaging with special emphasis of usefulness of 3-D volume rendered (VR) images in pre surgical evaluation.

Methods: A total of 500 paediatric patients (<18 years old), who had undergone MSCT were studied during the period 2014 to 2019 at the tertiary cardiac care centre.

Results: 500 patients having primary/suspicious diagnosis of DORV on echocardiography during the said period were enrolled in the study. All the patients who underwent MSCT scan, were studied in detail for: DORV spectrum, associated types of VSD and its relationship to the semilunar valves. Out of 500 total subjects, subaortic VSD was the most common type of VSD observed (53%), followed by subpulmonic VSD (22%), non-committed VSD (18%) and doubly committed VSD (7%). Associations of pulmonary stenosis, subaortic stenosis and aortic co-arctation with various types of VSDs were addressed. Associated other anomalies were also analysed.

Conclusions: Advances in MSCT technology has revolutionized pre-surgical diagnosis, management approach and post-operative follow-up of DORV patients. Excellent image qualities along with 3D volume rendered images help surgeon understand complex morphology of DORV variants and associated types of VSD. Significant reduction in intra and post-operative mortality in DORV patients in current era is result of MSCT technology.


Double outlet of right ventricle, Multislice computed tomography, Ventricular septal defect, 3- Dimensional volume rendered technique

Full Text:



Walters HL, Mavroudis C, Tchervenkov CI, Jacobs JP, Lacour GF, Jacobs ML. Congenital heart surgery nomenclature and database project: double outlet right ventricle. Ann Thorac Surg. 2000;69:249-63.

Lev M, Bharati S, Meng L, Liberthson RR, Paul MH, Idriss F. A concept of double outlet right ventricle. J Thorac Cardiovasc Surg. 1972;64:271-81.

Wilcox BR, Ho SY, Macartney FJ, Becker AE, Gerlis LM, Anderson RH. Surgical anatomy of double outlet right ventricle with situs solitus and atrioventricular concordance. J Thorac Cardiovasc Surg. 1981;92:405‐17.

Sebastian L, Erwin O, Lars H. Pre and postoperative evaluation of congenital heart disease in children and adults with 64-section CT. Radiograph. 2007;27:3-6.

Van PR, Geva T, Kreutzer J. Ventricular septal defects: how shall we describe, name, and classify them? J Am Coll Cardiol. 1989;14:1298-9.

Stellin C, Zuberbuhler JA, Anderson RH, Siewers RD. The surgical anatomy of the Taussig-Bing malformation. J Thorac Cardioasc Surg. 1987;93:560-9.

Chen SJ, Lin MT, Liu KL, Chang CI, Chen HY. Usefulness of 3D reconstructed computed tomography imaging for double outlet right ventricle. J Formos Med Association. 2008;107(5):371-80.

Shi K, Yang ZG, Chen J, Zhang G, Xu HY. Assessment of double outlet right ventricle associated with multiple malformations in pediatric patients using retrospective ECG-gated dual-source computed tomography. Plos One. 2015;10(6):0130987.

Yoo SJ, Thabit O, Lee W. Double outlet right ventricle in your hands, 12 case series. Fronti Pedia. 2018;5:1-6.

Aoki M, Forbess JM, Jonas RA, Mayer RE, Castaneda AR. Results of biventricular repair for double outlet right ventricle. Thorac Cardiovasc Surg. 1984;107:338-50.

Kleinert S, Sano T, Weintraoub RG, Karl TR, Wilkinson JL. Anatomic features and surgical strategies in double outlet right ventricle. Circulation. 1997;96:1233-9.

Belli E, Serraf A, Lacour GF, Inamo J, Houyet L, Bruniaux J, et al. Surgical treatment of subaortic stenosis after biventricular repair of double outlet right ventricle. J Thorac Cardiovasc Surg. 1996;122:1570-80.

Brown JW, Ruzmetov M, Okada Y, Vijay P, Turrentine MW. Surgical results in patients with d ouble outlet right ventricle: a 20 year experience. Ann Thorac Surg. 2001;72:630-5.

Bradley T, Karamlou T, Kulik A, Mitrovic B, Vigneswara T, Jaffer S, et al. Determinants of repair type, reintervention, and mortality in 393 children with double outlet right ventricle. J Thorac Cardiovasc Surg. 2007;134:969-73.