Cardiac tamponade after pulmonary valvuloplasty for presumed pulmonary valvular stenosis in a patient with double-chambered right ventricle: An unexpected diagnosis during emergency surgery

Abstract

Corresponding author: Sahin Bozok, M.D. Recep Tayyip Erdogan Universitesi Tip Fakultesi Kalp ve Damar Cerrahisi Anabilim Dali, 53200 Rize, Turkey. Tel: +90 464 217 03 65 e-mail: sahinboz@yahoo.com Double-chambered right ventricle (DCRV) is a rare cardiac congenital anomaly characterized by an obstruction of subinfundibular region by abnormal muscle bands. Herein, we report a case with DCRV and cardiac tamponade requiring urgent surgery following pulmonary valvuloplasty due to presumed pulmonary valvular stenosis. A 42-year-old female patient was admitted to cardiology department with a complaint of dyspnea. The patient was diagnosed with pulmonary valvular stenosis by echocardiography and cardiac catheterization. A maximum hemodynamic gradient of 110 mmHg was detected in the right ventricular outf low tract (RVOT). The patient required emergency surgery due to the right atrial laceration and cardiac tamponade following an attempt for pulmonary valvuloplasty. Right atrial injury was repaired by primary suturing and a longitudinal incision was made to the RVOT. A fibrotic, circular muscular ring in the subinfundibular region was resected. Pressure tracings from the right ventricle and pulmonary arteries revealed resolution of pressure gradient. Preoperative correct diagnosis of DCRV and associated pathologies increase the success of surgical procedures and may prevent unexpected complications for both the surgeon and the patient.