Double Outlet Right Ventricle

What is Double Outlet Right Ventricle

Double outlet right ventricle is a heart condition that makes the heart work extra hard to pump blood.

This condition happens when blood carrying oxygen (oxygen-rich blood) gets mixed with blood that is not carrying oxygen (oxygen-poor blood) because of the following defects:

• There is a hole between the right and left chambers of the heart (septal defect).
• The blood vessel that carries blood from the heart to the body (aorta) is in the wrong place.

What are the causes of Double outlet right ventricle ?

The cause of this condition is not known. Children with this condition are born with it.

What are the signs or symptoms of Double outlet right ventricle ?

Symptoms of this condition begin soon after birth. They may include:

• Rapid breathing.
• Trouble breathing.
• Bluish skin, lips, and nails (cyanosis).
• Poor feeding.
• Inability to gain weight.
• Sweating.
• Swelling of the legs and belly.

How is this diagnosed?

This condition may be diagnosed based on your child’s symptoms and a physical exam. During the exam, your child’s health care provider may listen for an abnormal heart sound (murmur). The diagnosis may be confirmed with tests, including:

• Pulse oximetry. This involves measuring the amount of oxygen in the blood with a sensor placed on a finger or toe.
• A chest X-ray.
• An electrocardiogram (ECG). This test records the electrical activity of the heart.
• Echocardiogram. This is a kind of ultrasound that shows how blood flows in the heart.
• Cardiac catheterization. In this test, a flexible tube (catheter) is put in the heart to check the oxygen levels and blood pressure.

How is this treated?

This condition is treated with surgery. Until the time of surgery, your baby may be treated with medicines to help the heart. After surgery, most children with this condition need to take medicines throughout life.

Follow these instructions at home:

• Give your child over-the-counter and prescription medicines only as told by the child’s health care provider.
• Have your child return to his or her normal activities as told by your child’s health care provider. Ask the health care provider what activities are safe for your child.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Your child has a fever.
• Your child has any new symptoms.
• Your child is not feeding well.
• Your child is not gaining weight.

Get help right away if:

• Your child has cyanosis.
• Your child has trouble breathing.

Double Outlet Right Ventricle Surgery

Double-outlet right ventricle surgery is a procedure to repair double-outlet right ventricle, a heart defect that makes it hard for your child’s heart to pump oxygen-rich blood to the body.

This surgery is done to try to restore normal blood flow through the heart. It is usually done soon after birth. This procedure may be done in stages.

What are the risks?

As with any procedure, complications may occur. Possible complications include:

• Bleeding.
• Infection.
• Damage to the nerves or muscles in the chest.
• Damage to the electrical system in the heart.
• Strokes.
• Blood clots.
• Kidney failure.
• Lung (respiratory) failure.

These complications can be life-threatening.

What happens before the procedure?

• Follow instructions from the health care provider about eating or drinking restrictions.
• Ask the health care provider about:
  • Changing or stopping your child’s regular medicines. This is especially important if your child is taking diabetes medicines or blood thinners.
  • Giving your child medicines such as aspirin and ibuprofen. These medicines can thin your child’s blood. Do notgive these medicines before the procedure if the health care provider instructs you not to.
• Your child may be given antibiotic medicine to help prevent infection.
• If the child is already in the hospital, an IV tube will be placed the night before surgery. Fluids may be given through this tube.
• Your child may be in the hospital for a few days or longer. Make plans for someone to stay with your child every night, if possible.

What happens during the procedure?

• To reduce your child’s risk of infection:
  • Your child’s health care team will wash or sanitize their hands.
  • Your child’s skin will be washed with soap.
• An IV tube will be placed. It will be used to give your child fluids and medicine during the procedure.
• Your child will be given one or more of the following:
  • A medicine to help him or her relax (sedative).
  • A medicine to make him or her fall asleep (general anesthetic).
• A machine called a ventilator will be used to help your child breathe.
• Your child will have several tubes put in, including:
  • A tube that goes into the windpipe so that breathing can be controlled during surgery.
  • More IV tubes.
  • A small tube that goes from the nose down to the stomach.
  • A tube that lets urine drain from the body.
• An ultrasound test will be done to create pictures of your child’s heart.
• A cut (incision) will be made through the breastbone or under the arm.
• Your child may be connected to a heart-lung bypass machine. This machine will provide your child with oxygen during the procedure.
• Your child’s heart will be repaired.
• Your child will be taken off the heart-lung bypass machine.
• Medicine may be given to help the heart beat well.
• A small, clear chest tube will be placed. It will be used to drain extra fluid and air from the chest.
• Electrical wires may be put in to make sure the heart is working normally. These are temporary.
• The incision will be closed with stitches (sutures), skin glue, or adhesive strips.
• A bandage (dressing) will be placed over the incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your child will be brought to the intensive care unit (ICU).
• Many of the tubes and wires placed during surgery will be left in place during the first few hours or days of recovery.
• Your child may still be on a ventilator.
• X-rays and blood tests will be done.
• Your child may get medicine to improve blood pressure.
• Your child’s blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often.
• Over time your child will need to be monitored less and less. Tubes will be removed, and the child will be taken off of the ventilator to breathe on his or her own.

Contact a health care provider if:

• Any allergies your child has.
• All medicines your child is taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Previous problems your child or members of your family have had with the use of anesthetics.
• Any blood disorders your child has.
• Previous surgeries your child has had.
• Any medical conditions your child has.

Care After Double Outlet Right Ventricle Surgery

These instructions provide you with information about caring for your child after his or her procedure. Your child’s health care provider may also give you more specific instructions.

Your child’s treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if your child has any problems after the procedure or if you have any questions.

What can I expect after the procedure?

After the procedure, it is common for your child to have:

• Pain.
• Nightmares or trouble sleeping.

Follow these instructions at home:

Medicines

• Give prescription medicines only as told by your child’s health care provider.
• Do notgive your child any over-the-counter medicines without first talking to your child’s health care provider. The medicines may interact with the other medicines your child is taking.

Incision care

• Follow instructions from your child’s health care provider about how to take care of your child’s cut from surgery (incision). Make sure you:
  • Wash your hands with soap and water before you change the bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change the dressing as told by your child’s health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to be in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your child’s health care provider tells you to.
• Check your child’s incision every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Bathing

• For 1 week after the surgery:
  • Do notlet bath water cover your child’s chest.
  • Give your child sponge baths.
  • Clean the area around the incision with mild soap and water.

General instructions

• If your child had an incision through the breastbone, until the area heals:
  • Lift your child by putting one arm under your child’s bottom and the other behind your child’s back.
  • Do notlift your child by putting your hands under your child’s arms.
  • Do notallow your child to wear a backpack.
• Follow any instructions given to you about diet and nutrition supplements.
• Tell all your child’s health care providers that your child has had surgery. Your child should not have routine immunizations until at least 8 weeks after surgery.
• Consider joining a support group for families who have had a child who needed this surgery.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Your child has a fever.
• Your child is not feeding or eating well.
• Your child is not gaining weight.
• Your child tires quickly while eating or playing.
• Your child’s abdomen or legs swell.
• Your child’s lips or nails look bluish in color (cyanosis).

Get help right away if:

• The incision is bleeding.
• There is more redness, swelling, or pain around the incision.
• There is more fluid coming from the incision.
• The incision feels warm to the touch.
• There is pus or a bad smell coming from the incision.
• Your child who is younger than 3 months has a temperature of 100°F (38°C) or higher.
• Your child’s heart is beating too quickly or irregularly.
• You have difficulty arousing your child.
• Your child faints.
• Your child’s skin looks bluish or purplish and your child is struggling to breathe.