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2018-01-21  Atrioventricular discordance with double outlet right ventricle  © Ahmed Ezz

Atrioventricular discordance with double outlet right ventricle
*Ahmed Ezz El arab(M.Sc), **Dr . Sameh Abdel Latif Abdel Salam (M.D)
*Fetal medicine unit – Cairo university- Egypt 
**Radiology department, Kasr Alainy teaching hospitals  ,Cairo university, Egypt 

Case report

A woman (G2p1) come for routine examination at 38 weeks of pregnancy. Our 2D and Doppler examination of the fetal heart revealed findings of atrioventricular discordance with DORV:

- Position of the heart  :  mesocardia  with mild cardiomegaly 
- Stomach normally situated in left side 
- Position of morphologically right ventricle is anterior to the left side  and connected to left  atrium through tricuspid valve
-Position of  morphologically left ventricle is posterior to the right side and connected  to right atrium through mitral vale
-N.B :  Valves is connected to  ventricles
- Left atrium shows  its characterized left atrial appendage ( finger like projection, to the  left side)
- Right atrium shows its characterized right atrial appendage (broad pyramidal shaped, to the right side)
So the switch is at the ventricular level  
-As the Morphologically right ventricle is more anterior and morphologically left ventricle is more posterior, this means that the ventricles are D looped

Examination of ventriculoarterial connection revealed

-Both aorta and pulmonary arteries are arising from morphologically right ventricle 
-Aorta is left  anterior and more cephalic to pulmonary artery ( which is right posterior more caudal  to aorta) 
-The size of aorta is larger than size of pulmonary artery meaning that there is pulmonary stenosis ( mostly mild valvar stenosis) 
- AS regard VSD : it is inlet VSD with  outlet extension ( no overriding of any great arteries over the  septum  meaning   that both arteries arising completely from right ventricle)
VSD  is  non –committed  VSD ( away from great arteries )

There is severe mitral regurgitation, most properly due to mal function of left ventricle.
SVC and IVC ( superior vena cava  and inferior vena cava ) were normally connected to right atrium 
- Pulmonary veins were normally connected to left atrium .



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