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Published on: July 18, 2014
Transatrial repair of double-chambered right ventricle
D K Ford1, C A Bullaboy, W M Derkac
1Division of Pediatric Cardiology, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk 23507.
Insights
Transatrial repair of double-chambered right ventricles (DCRV) offers a viable alternative to traditional surgery. This approach in 8 children demonstrated excellent outcomes with minimal complications, suggesting its potential as a preferred method for DCRV repair.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiac Anatomy
Background:
- Double-chambered right ventricle (DCRV) is a congenital heart defect.
- Traditional surgical repair involves a right ventriculotomy.
- Alternative approaches are sought to improve outcomes and reduce invasiveness.
Purpose of the Study:
- To evaluate the safety and efficacy of transatrial repair for DCRV.
- To compare the transatrial approach with the traditional transventricular method.
- To assess short- and long-term outcomes in pediatric patients undergoing DCRV repair.
Main Methods:
- Retrospective review of 8 pediatric patients with DCRV undergoing surgical repair.
- Repair was performed via a right atriotomy approach.
- Data collected included patient demographics, pre- and post-operative gradients, bypass times, and clinical outcomes.
Main Results:
- Mean intraoperative gradients post-repair were significantly reduced (5.8 mm Hg).
- Most patients remained asymptomatic post-hospitalization with good long-term follow-up.
- Transient atrioventricular block and minimal inotropic support were the main postoperative complications.
Conclusions:
- Transatrial repair of DCRV provides excellent anatomical visualization during surgery.
- This approach is a safe and effective alternative to the transventricular repair for DCRV.
- Further consideration of the transatrial approach is warranted for DCRV management in children.
Abstract:
Double-chambered right ventricles (DCRVCs) traditionally have been repaired via a right ventriculotomy. We describe the cases of 8 children (aged 7 months to 6 years; weight, 6.3 to 21.5 kg), who underwent repair of DCRV via a right atriotomy. Six patients had ventricular septal defects. Peak systolic gradients in the right ventricular outflow tract were 26 to 135 mm Hg. The QP/QS were 1.1 to 2.5. Cardiopulmonary bypass times were 52 to 89 min (mean, 65.5 min) with aortic cross-clamp times of 20 to 56 min (mean, 39 min). Mean intraoperative gradients following repair were 5.8 mm Hg. Three patients had transient postoperative atrioventricular block requiring temporary pacing. Two patients required minimal inotropic support (dopamine, 2.5 to 5 micrograms/kg/min). The children have all been asymptomatic after hospitalization with follow-up times of 5 months to 4.5 years. No patient requires cardiac medications or has significant, persistent dysrhythmias; however, 1 patient required reoperation. Transatrial repair of DCRV allows excellent operative anatomical visualization and should be considered as an alternative to the transventricular approach in patients with this congenital heart defect.
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