Double-chambered right ventricle in adults: Invasive and noninvasive hemodynamic considerations

Abstract

Background: Data on the features of double-chambered right ventricular (DCRV) in adults are limited. It is also unclear how invasive and Doppler-derived assessments of right ventricular (RV) obstruction in DCRV correlate. Methods: Retrospective review of 17 adults (age ≥18 years) diagnosed with DCRV who underwent right heart catheterization at Mayo Clinic, MN between 1990 and 2021. Clinical, echocardiographic, and invasive hemodynamics were abstracted from the medical charts. Results: Mean age was 44 ± 19 years and 7 (41%) patients were female. Two patients (12%) had undergone prior surgical repair of DCRV with ventricular septal defect (VSD) closure and had residual/recurrent obstruction; a VSD had been previously documented in 16 patients (94%). RV inflow to pulmonary artery systolic gradient at catheterization was 42 (19; 95) mmHg. The correlation coefficient between RV inflow to pulmonary artery systolic gradients and Doppler-derived peak gradients was 0.87 (p < 0.0001); the coefficient between the RV inflow to pulmonary artery systolic gradients and Doppler-derived systolic mean gradients was 0.85. Doppler-derived maximum instantaneous gradients were significantly higher than directly measured values (p = 0.002) while no difference was seen when invasive gradients were compared to Doppler-derived systolic mean gradients (p = 0.16). There was no association between New York Heart Association functional class III/IV, presence of dyspnea or syncope/pre-syncope and invasively measured RV gradients. Conclusion: Significant discrepancy between non-simultaneous echo-derived and invasively measured intracavitary RV gradients was seen in adults with DCRV. There was no correlation between the degree of RV obstruction and symptoms/functional capacity.

Keywords

• Double-chambered right ventricle
• Doppler
• Cardiac catheterization