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J Thorac Cardiovasc Surg 1999;117:1180-1187
© 1999 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

THE NATURE OF THE OBSTRUCTIVE MUSCULAR BUNDLES IN DOUBLE-CHAMBERED RIGHT VENTRICLE

From Paediatrics, National Heart and Lung Institute, Royal Brompton Campus, Imperial College School of Medicine,^a and the Clinical Trials and Evaluation Unit, Royal Brompton Hospital,^b London, United Kingdom.

Professor Anderson and Dr Ho are supported by the British Heart Foundation and the Joseph Levy Foundation. Dr Carlos Alva was a visiting research fellow from Hospital de Cardiologia Centro Medico Nacional Siglo XXI, Mexico City, Mexico.

Received for publication Aug 25, 1998. Revisions requested Dec 11, 1998. Revisions received Jan 20, 1999. Accepted for publication Feb 26, 1999. Address for reprints: R. H. Anderson, Paediatrics, National Heart and Lung Institute, Royal Brompton Campus, Imperial College School of Medicine, Dovehouse St, London SW3 6LY, United Kingdom.

Objective: Our goal was to establish the morphologic nature of the obstructive muscular lesions in double-chambered right ventricle.
Methods: We based our morphologic observations on 10 normal hearts and on the surgical findings in 26 patients, aged 0.5 to 24 years, with a mean of 6.9 years (SD 5.8 years). In the normal hearts, we measured the distance from the pulmonary valve to the apex of the right ventricle and from the takeoff of the moderator band to the ventricular apex. From angiograms available in 20 patients, using the frontal view, we then measured the distance from the pulmonary valve to the apex of the right ventricle and from the midpoint of the obstructive lesion to the apex of the right ventricle. This permitted calculations of multiple ratios.
Results: In the 10 normal hearts, the moderator band took origin at a mean ratio of 0.48 (SD 0.16) of the ventricular length. On the basis of the angiographic findings, we identified 2 basic forms of double-chambered right ventricle. In 9 patients, the obstructive muscular shelf was positioned low and diagonally across the apical component, with a mean ratio of 0.38 relative to the ventricular length (SD 0.02). In the other 11 patients, the obstructive shelf was high and horizontal, with a mean ratio of 0.27 (SD 0.02). The difference was statistically significant (P = .001). Surgical repair was performed successfully in all 26 patients through a right ventriculotomy.
Conclusions: Double-chambered right ventricle is the consequence of a high or low muscular division of the apical component of the right ventricle. The abnormal muscular bundle probably represents accentuated septoparietal trabeculations, rather than always being an abnormal moderator band. (J Thorac Cardiovasc Surg 1999;117:1180-9)

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