The morphologic spectrum of double outlet left ventricle and its surgical significance

Abstract

Double outlet left ventricle (DOLV) is defined in this paper as that condition in which both great arterial vessels emerge completely (complete form) or mostly (incomplete form) from the morphologic left ventricle. This is a study of eight cases diagnosed during surgery and 37 cases diagnosed at autopsy. DOLV was classified as follows: with the aorta to the right or to the right and posterior to the pulmonary trunk: a) with ventricular septal defect (VSD) confluent with the aorta (10 cases), b) with VSD confluent with the pulmonary trunk (three cases), and c) with VSD confluent with both vessels (two cases), with aorta anterior to, anterior and to the right, or anterior and to the left of the pulmonary trunk: a) with the VSD related to the aorta (10 cases), b) with the VSD related to the pulmonary trunk (one case), and c) with the VSD related to both vessels (two cases) with tricuspid valve abnormalities: a) with tricuspid atresia and stenosis with normally related vessles (four cases), or aorta anterior (10 cases), b) with straddling or displaced tricuspid valve (two cases), or c) with Ebstein's anomaly (one case). 5 surgical and 4 autopsied cases were of the complete form. From the surgical standpoint, it is important in DOLV to determine the interrelationship and origin of the great arteries, their relationship to the VSD, and the location of the VSD in the ventricular septum. The presence of tricuspid valve abnormalities is emphasized.