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Double outlet right ventricle

DORV; Taussig-Bing anomaly; DORV with doubly-committed VSD; DORV with noncommitted VSD; DORV with subaortic VSD; Congenital heart defect - DORV; Cyanotic heart defect - DORV; Birth defect - DORV

Double outlet right ventricle (DORV) is a heart disease that is present from birth (congenital). The aorta connects to the right ventricle (RV, the chamber of the heart that pumps oxygen-poor blood to the lungs), instead of to the left ventricle (LV, the chamber that normally pumps oxygen-rich blood to the body).

Both the pulmonary artery (which carries oxygen-poor blood to the lungs) and aorta (which carries oxygen-rich blood from the heart to the body) come from the same pumping chamber. No arteries are connected to the left ventricle (the chamber that normally pumps blood to the body).

Causes

In a normal heart structure, the aorta connects to the LV. The pulmonary artery normally is connected to the RV. In DORV, both arteries flow out of the RV. This is a problem because the RV carries oxygen-poor blood. This blood is then circulated throughout the body.

Another defect called a ventricular septal defect (VSD) always occurs with DORV.

Oxygen-rich blood from the lungs flows from the left side of the heart, through the VSD opening and into the RV. This helps the infant with DORV by allowing oxygen-rich blood to mix with oxygen-poor blood. Even with this mixture, the body may not get enough oxygen. This makes the heart work harder to meet the body's needs. There are several types of DORV.

The difference between these types is the location of the VSD as it relates to the location of the pulmonary artery and aorta. The symptoms and severity of the problem will depend on the type of DORV. The presence of pulmonary valve stenosis also affects the condition.

People with DORV often have other heart defects, such as:

  • Endocardial cushion defects (the walls separating all four chambers of the heart are poorly formed or absent)
  • Coarctation of the aorta (narrowing of the aorta)
  • Mitral valve problems
  • Pulmonary atresia (pulmonary valve does not form properly)
  • Pulmonary valve stenosis (narrowing of the pulmonary valve)
  • Right-sided aortic arch (aortic arch is on right instead of the left)
  • Transposition of the great arteries (the aorta and pulmonary artery are switched)

Symptoms

Signs of DORV may include:

  • Enlarged heart
  • Heart murmur
  • Rapid breathing
  • Rapid heartbeat

Symptoms of DORV may include:

  • Poor feeding from becoming tired easily
  • Bluish color of the skin and lips
  • Clubbing (thickening of the nail beds) of toes and fingers (late sign)
  • Failure to gain weight and grow
  • Pale coloring
  • Sweating
  • Swollen legs or abdomen
  • Trouble breathing

Exams and Tests

Tests to diagnose DORV include:

Treatment

Treatment requires surgery to close the hole in the heart and direct blood from the left ventricle into the aorta. Surgery may also be needed to move the pulmonary artery or aorta.

Factors that determine the type and number of operations the baby needs include:

  • The type of DORV
  • The severity of the defect
  • The presence of other problems in the heart
  • The child's overall condition

Outlook (Prognosis)

How well the baby does depends on:

  • The size and location of the VSD
  • The size of the pumping chambers
  • The location of the aorta and pulmonary artery
  • The presence of other complications (such as coarctation of the aorta and mitral valve problems)
  • The baby's overall health at the time of diagnosis
  • Whether lung damage has occurred from too much blood flowing to the lungs for a long period of time

Possible Complications

Complications from DORV may include:

  • Heart failure
  • High blood pressure in the lungs, which untreated can lead to permanent lung damage
  • Death

Children with this heart condition may need to take antibiotics before dental treatment. This prevents infections around the heart. Antibiotics may also be needed after surgery.

When to Contact a Medical Professional

Call your health care provider if your child seems to tire easily, has trouble breathing, or has bluish skin or lips. You should also consult your provider if your baby is not growing or gaining weight.

References

Bichell D. Double-outlet right ventricle. In: Ungerleider RM, Meliones JN, McMillian KN, Cooper DS, Jacobs JP, eds. Critical Heart Disease in Infants and Children. 3rd ed. Philadelphia, PA: Elsevier; 2019:chap 58.

Haller C, Van Arsdell GS, Yoo S-J, George-Hyslop CST, Spicer DE, Anderson A. Double-outlet ventricle. In: Wernovsky G, Anderson RH, Kumar K, et al. Anderson's Pediatric Cardiology. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 39.

Webb GD, Smallhorn JF, Therrien J, Redington AN. Congenital heart disease in the adult and pediatric patient. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 75.

Text only

  • Congenital heart defects (CHD) overview

    Congenital heart defects (CHD) overview

    Animation

  •  

    Congenital heart defects (CHD) overview - Animation

    Congenital heart disease describes defects of the heart or its vessels that are present at birth. They are the most common types of birth defect, affecting 1 out of every 120 babies. Some heart defects are severe, but many are not, ranging from simple defects with no symptoms, to complex defects with severe life-threatening symptoms. Each year, more than 35,000 babies in the United States are born with congenital heart defects. Most are simple defects that are easily corrected or do not need treatment. However, a small number of babies are born with complex heart defects and require special medical attention soon after birth. Over the past few decades, the diagnosis and treatment of these complex defects has greatly improved. Thanks to new and effective treatments, almost all children with complex heart defects grow to adulthood and can live active, productive lives. Most of these patients will nonetheless continue to need special heart care throughout their lives. Living with a congenital heart disease can also impact health insurance, employment, pregnancy, contraception, and the risk of infection during routine health procedures. Today, approximately 1 million American adults are living with congenital heart defects.

  • Double outlet right ventricle

    Double outlet right ventricle - illustration

    Double outlet right ventricle (DORV) is a congenital heart disease in which the aorta and pulmonary artery rise from the right ventricle. This configuration allows oxygen-poor blood, to be carried throughout the body. The body is not able to get enough oxygen, causing the heart to work harder to try to bring more oxygen-rich blood to the body.

    Double outlet right ventricle

    illustration

  • Congenital heart defects (CHD) overview

    Animation

  •  

    Congenital heart defects (CHD) overview - Animation

    Congenital heart disease describes defects of the heart or its vessels that are present at birth. They are the most common types of birth defect, affecting 1 out of every 120 babies. Some heart defects are severe, but many are not, ranging from simple defects with no symptoms, to complex defects with severe life-threatening symptoms. Each year, more than 35,000 babies in the United States are born with congenital heart defects. Most are simple defects that are easily corrected or do not need treatment. However, a small number of babies are born with complex heart defects and require special medical attention soon after birth. Over the past few decades, the diagnosis and treatment of these complex defects has greatly improved. Thanks to new and effective treatments, almost all children with complex heart defects grow to adulthood and can live active, productive lives. Most of these patients will nonetheless continue to need special heart care throughout their lives. Living with a congenital heart disease can also impact health insurance, employment, pregnancy, contraception, and the risk of infection during routine health procedures. Today, approximately 1 million American adults are living with congenital heart defects.

  • Double outlet right ventricle

    Double outlet right ventricle - illustration

    Double outlet right ventricle (DORV) is a congenital heart disease in which the aorta and pulmonary artery rise from the right ventricle. This configuration allows oxygen-poor blood, to be carried throughout the body. The body is not able to get enough oxygen, causing the heart to work harder to try to bring more oxygen-rich blood to the body.

    Double outlet right ventricle

    illustration

 

Review Date: 7/7/2020

Reviewed By: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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