Double-Chambered Right Ventricle: An Intraoperative Surprise

DOUBLE-CHAMBERED RIGHT VENTRICLE (DCRV) is a congenital anomaly that results in the creation of high-pressure and a low-pressure chambers within the RV. The high-pressure chamber is typically the proximal inflow portion of the ventricle, whereas the low-pressure chamber is the distal outflow portion of the ventricle.1 The 2 chambers are separated typically 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 con-dition usually is 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 diag-nosis in adulthood, as it may be difficult to visualize the 2 dis-tinct chambers of the RV with a transthoracic echocardiogram (TTE), and adults can often be asymptomatic. When symp-toms are present, they are generally nonspecific in nature, such as dyspnea or exercise intolerance, which can lead to misdiag-nosis.4 Once diagnosed, it must be corrected surgically to pre-vent right-heart failure.5 Due to the rarity of the presentation of DCRV in adulthood, the authors report a case of a 59-year -old woman who was found incidentally to have DCRV intrao-peratively just prior to the start of her concomitant coronary artery bypass (CAB) and VSD closure procedures.