Double Outlet Right Ventricle (DORV),WEI NI,1.with or without transposition of the great arteries2.ventricular septal defect(VSD)3.pulmonary hypertensionor pulmonary stenosis (PH or PS),What if there are defects :,Definition,“DORV is a type of congenital heart disease which both great arteries arise either entirely or predominantly from the right ventricle”,The Society of Thoracic Surgeons(STS) And European Association for Cardio-Thoracic Surgery(EACTS）-2000,spatial relationship of the semilunar cusps in hearts with DORV, . Great Arteries Relationship,D-malposition（12%）,L-malposition（5%）,Parallel（29%）,Normal AN,AA,. Location of VSD,Classification of the interventricular communication / VSD according to its location in relation to the great arteriessubaortic (65%)subpulmonary (20-25%)doubly committed (3%)non committed (7%),A vast importance to surgical operation,rather than anatony or embryology,size in relation to the diameter of the aortadistance between VSD and aortic valve(overriding 70%)presence and severity of a subpulmonary obstruction,subaortic VSD,VSD belows the aortic valve overriding 70% PH or PS,subaortic VSD,parasternal long axis,Ao,Ao,LV,LA,RV,RV,Ao,PA,subaortic VSD with severe pulmonary stenosis,subaortic VSD,PA,Ao,subpulmonary VSD,size in relation to the diameter of the pulmonary arterypresence and severity of a subpulmonary obstruction,VSD belows the pulmonary valve Overriding PH or PS,subpulmonary VSD,RV,RV,PA,PA,doubly Committed VSD,VSD belows both the aorta and the pulmonary arterypresence and severity of a subpulmonary obstruction,non-committed VSD,VSD is in a position away from the great arteriespresence and severity of a subpulmonary obstructionsubcostal coronal / 4 C views,LV,Ao,RV,LV,LV,RV,RV,AO,RV,AO,The type of DORV,According to: arterial interrelationshipAN AA(TGA) location of VSD A-VSD N-VSD pulmonary hypertension or pulmonary stenosis PH PS,I AN A-VSD PH,AO,RV,LV,PA,AO,II AN A-VSD PS,AO,AO,PS,AO,LA,LA,III AN N-VSD PH,AO,PA,PA,IV AN N-VSD PS,conal septum,conal septum,V AA A-VSD PH,VI AA A-VSD PS,PA,AO,VII AA N-VSD PH,VIII AA N-VSD PS,VIII AA N-VSD PS,semilunar valves side-by-side (AN)DORV with subpulmonary VSD (A-VSD)no subpulmonary obstruction (no PS)semilunar valves and AV-valves separated by conal septum,Taussig-Bing malformation ( special type),Summary,1.morphology and size of both ventricles and AV-valves2. arterial interrelationship3. Location of VSD and the diameter of arteries4. location and severity of a subpulmonary or subaotic obstruction,Question,How can we distinguish DORV(II) from TOF?,DORV,TOF,DORV,DORV,DORV,DORV,DORV(II),Conalseptum,Next Content,1. physiopathology 2. clinical manifestation 3. surgical palliation and surgical repair,Reference book,Clinicl Echocardiography(P:680-703) Guideline DORV From DGPK,THANK YOU FOR YOU ATTENTION!,