Late development of left ventricular outflow tract obstruction after repair of double-outlet right ventricle

A 22-year-old woman had exertional chest pain and dyspnea secondary to left ventricular outflow tract obstruction more than a decade after repair of a type I double-outlet right ventricle. The obstruction was the result of (1) failure of the ventricular septal defect and the tunnel created between the left ventricle and aorta to enlarge commensurate with growth of the heart and (2) a markedly hypertrophied parietal band of the crista supraventricularis which surrounded and narrowed the aortic orifice. At reoperation, the ventricular septal defect and the tunnel were enlarged and the hypertrophied crista supraventricularis was partially resected. The patient is asymptomatic 6 months after operation.