Double-Chambered Right Ventricle:An Intraoperative Surprise

Abstract

Double-chambered right ventricle (DCRV) is a congenital anomaly that results in the creation of a high-pressure and a low-pressure chamber within the right ventricle. The high-pressure chamber is typically the proximal inflow portion of the ventricle while the low-pressure chamber is the distal outflow portion of the ventricle.1 The two chambers are typically separated by anomalous muscle bands, which are present in infancy and become progressively larger, leading to further outlet obstruction as the child grows.2 Although rare, this condition is usually discovered and surgically treated in childhood and adolescence and is often associated with other congenital anomalies, most frequently ventricular septal defects (VSD) (90%).3 Occasionally DCRV is not detected in childhood, and adults can present with the condition. It can be a difficult diagnosis in adulthood as it may be difficult to visualize the two distinct chambers of the right ventricle with a trans-thoracic echocardiogram (TTE) and adults can often be asymptomatic. When symptoms are present, they are generally nonspecific in nature such as dyspnea or exercise intolerance, which can lead to misdiagnosis.4 Once diagnosed it must be surgically corrected to prevent right heart failure.5 Due to the rarity of the presentation of DCRV in adulthood we report a case of a 59-year-old woman, who was incidentally found to have DCRV intra-operatively just prior to the start of her concomitant coronary artery bypass (CAB) and VSD closure procedure.