Isolated double-chambered right ventricle in an adult: A case report

Figure 1  12-lead electrocardiogram showing sinus rhythm at 60 bpm with right-axis deviation, and T wave inversion in the right pericardial and inferior leads.

Figure 2 Echocardiographic features of double-chambered right ventricle with right ventricular obstruction and Doppler assessment. A: Trans-thoracic echocardiogram, parasternal modified short-axis view (at mitral valve level) demonstrating a double-chambered right ventricle with a tunnel-like obstruction (arrow) due to a prominent right ventricular muscle bundle and right ventricular hypertrophy. The arrow highlights a right ventricular muscle bundle that forms the tunnel-like obstruction; B: Trans-thoracic echocardiogram, parasternal modified short-axis view demonstrating a double-chambered right ventricle with a tunnel-like obstruction (arrow) due to a prominent right ventricular muscle bundle. The arrow highlights a right ventricular muscle bundle that forms the tunnel-like obstruction; C: Color-Doppler demonstrating turbulence of flow across the right ventricular muscle bundle; D: Continuous-wave Doppler across the area of obstruction (intra-cavity), with an estimated peak gradient of 132 mmHg; E: Continuous-wave Doppler across the tricuspid valve, with an estimated peak gradient of 65 mmHg. dRV: Distal right ventricular chamber; LV: Left ventricular cavity; pRV: Proximal right ventricular chamber.

Figure 3 Intra-operative trans-esophageal echocardiography showing resolution of right ventricular outflow tract obstruction and reduced tricuspid regurgitation gradient. A: Intra-operative trans-esophageal echocardiography (trans-esophageal echocardiography; mid-esophageal, 0°) revealed a significant decrease in the tricuspid regurgitation gradient, decreasing from 65 mmHg to 29 mmHg; B: Two-dimensional trans-gastric trans-esophageal echocardiography view at 0° demonstrating alleviation of right ventricular outflow tract obstruction.

Figure 4 Post-operative trans-thoracic echocardiography showing resolution of right ventricular outflow tract obstruction and marked reduction in pressure gradient. A: Post-operative trans-thoracic echocardiography, parasternal short-axis view demonstrating laminar flow across the right ventricular outflow tract; B: Continuous-wave Doppler across the right ventricular outflow tract showing a reduction in post-operative right ventricular outflow tract gradient from 132 mmHg to almost 20 mmHg.