In 'Double Outlet Right Ventricle' (DORV) the two Great Arteries (Aorta and Pulmonary Artery) both originate from the right ventricle and blood from the left ventricle passes across a VSD into the RV to reach the great arteries. The lung circulation is often exposed to very high pressure and increased blood flow (as with a large VSD). There are many different varieties of this abnormality.

Different types of 'DORV"

The site of the VSD may vary and can affect the clinical manifestations and the options for surgery. The illustration below shows several variations.

The upper left diagram (1) shows an abnormality similar to Tetralogy of Fallot, but without obstruction to flow to the lungs. Repair involves placement of a patch within the right ventricle to direct LV flow to the aorta.

In the type called the 'Taussig Bing' anomaly (top right diagram 2) blood from the LV passes through the VSD to the Pulmonary Artery, whilst blood from the RV tends to be directed mainly to the Aorta. This is similar in many ways to Transposition with a VSD and It may be treated with an 'Arterial Switch' operation along with a patch within the right ventricle to direct flow to the arterial valve adjacent to the VSD.

The illustration labelled 'Doubly Committed VSD' (3) shows a rare variant which may be suitable for repair in a similar way to the first type. The fourth diagram shows a 'Non Committed VSD' (4) in which the VSD is distant from both arteries and blood 'mixes' in the right ventricle. This is sometimes suitable for repair but in other cases a Fontan procedure may be considered.

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