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Double-Chambered Right Ventricle and Bicuspid Pulmonic Valve
Journal of the American College of Cardiology Ó 2014 by the American College of Cardiology Foundation Published by Elsevier Inc.
Vol. 63, No. 6, 2014 ISSN 0735-1097/$36.00 http://dx.doi.org/10.1016/j.jacc.2013.08.1655
IMAGES IN CARDIOLOGY
Double-Chambered Right Ventricle and Bicuspid Pulmonic Valve A Thrilling Discovery Teerapat Yingchoncharoen, MD, Luke J. Burchill, MBBS, PHD, Janine Arruda, MD, Rodolfo Denadai Benatti, MD, Karen James, MD, W. H. Wilson Tang, MD, Robert D. Stewart, MD, MPH, Gösta B. Pettersson, MD, PHD, Karunakaravel Karuppasamy, MBBS, MSC Cleveland, Ohio
From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Manuscript received August 11, 2013; accepted August 20, 2013.
36-year-old woman presented with palpitations. Examination revealed a precordial thrill and grade 4/6 systolic ejection murmur. Echocardiography showed severe subinfundibular right ventricular outflow tract obstruction with a peak instantaneous gradient of 142 mm Hg (A, Online Video 1) and severe right ventricular hypertrophy. Right heart catheterization demonstrated a high-pressure proximal right ventricle (pRV) and low-pressure distal right ventricle (dRV) (D). These studies suggest that the right ventricle was divided into 2 chambers consistent with double-chambered right ventricle. Cardiac magnetic resonance imaging confirmed this finding (B, Online Video 2) and also showed a nonstenotic bicuspid pulmonic valve (C, arrows, Online Video 3). The patient underwent successful resection of an anomalous muscle bundle in the right ventricular outflow tract. There was no evidence of a ventricular septal defect on magnetic resonance imaging or intraoperative visualization. To our knowledge, this is the first reported case of concomitant double-chambered right ventricle and bicuspid pulmonic valve without ventricular septal defect. PA ¼ pulmonary artery; PV ¼ pulmonic valve; RA ¼ right atrium; TV ¼ tricuspid valve.
A
Vol. 63, No. 6, 2014 ISSN 0735-1097/$36.00 http://dx.doi.org/10.1016/j.jacc.2013.08.1655
IMAGES IN CARDIOLOGY
Double-Chambered Right Ventricle and Bicuspid Pulmonic Valve A Thrilling Discovery Teerapat Yingchoncharoen, MD, Luke J. Burchill, MBBS, PHD, Janine Arruda, MD, Rodolfo Denadai Benatti, MD, Karen James, MD, W. H. Wilson Tang, MD, Robert D. Stewart, MD, MPH, Gösta B. Pettersson, MD, PHD, Karunakaravel Karuppasamy, MBBS, MSC Cleveland, Ohio
From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Manuscript received August 11, 2013; accepted August 20, 2013.
36-year-old woman presented with palpitations. Examination revealed a precordial thrill and grade 4/6 systolic ejection murmur. Echocardiography showed severe subinfundibular right ventricular outflow tract obstruction with a peak instantaneous gradient of 142 mm Hg (A, Online Video 1) and severe right ventricular hypertrophy. Right heart catheterization demonstrated a high-pressure proximal right ventricle (pRV) and low-pressure distal right ventricle (dRV) (D). These studies suggest that the right ventricle was divided into 2 chambers consistent with double-chambered right ventricle. Cardiac magnetic resonance imaging confirmed this finding (B, Online Video 2) and also showed a nonstenotic bicuspid pulmonic valve (C, arrows, Online Video 3). The patient underwent successful resection of an anomalous muscle bundle in the right ventricular outflow tract. There was no evidence of a ventricular septal defect on magnetic resonance imaging or intraoperative visualization. To our knowledge, this is the first reported case of concomitant double-chambered right ventricle and bicuspid pulmonic valve without ventricular septal defect. PA ¼ pulmonary artery; PV ¼ pulmonic valve; RA ¼ right atrium; TV ¼ tricuspid valve.
A