Double-Chambered Right Ventricle Repair With Robotic Assistance

A 28-year-old female, a known case of congenital heart disease, presented with dyspnea on exertion and increased fatigability over two months. Clinical examination revealed a harsh ejection systolic murmur (Grade 4/6) at the left upper sternal border radiating to the infraclavicular region, accompanied by a palpable thrill. 
 
Initial echocardiography confirmed a double-chambered right ventricle (DCRV) with a hypertrophied right ventricular outflow tract (RVOT) muscle bundle causing a gradient of 150 mmHg. Further imaging, including cardiac MRI, revealed severe right ventricular outflow tract obstruction (RVOTO) due to a 14 mm thick, 36 mm long muscle bundle dividing the right ventricle (RV) into high-pressure proximal and low-pressure distal chambers, with associated aneurysmal dilatation. Mild tricuspid regurgitation, right atrial dilation, and right ventricular hypertrophy were also noted. 
 
Under robotic assistance using the da Vinci X surgical system), the patient underwent successful resection of the RVOT muscle bundle. Peripheral bypass was established via femoral cannulation, and robotic ports were strategically placed in the third, fourth, and fifth intercostal spaces, with additional ports for the retraction arm and Chitwood aortic clamp. Following systemic heparinization and cardiopulmonary bypass, pericardial stays were taken, and the superior and inferior vena cava were looped and snugged. The heart was arrested with cold root cardioplegia, and the right atrium was opened. The tricuspid valve was retracted using robotic arms to expose the hypertrophied muscle bundle. 
 
The obstructing bands were carefully divided and excised using robotic scissors and cautery. After ensuring there was no residual obstruction, the right atrium was closed, and the patient was successfully weaned off bypass. Postoperative transesophageal echocardiography revealed no residual obstruction (RVOT gradient 9 mmHg), no tricuspid regurgitation, and preserved biventricular function. 
 
This case highlights the utility of robotic assistance in managing rare congenital anomalies such as DCRV, offering enhanced visualization and precision in resection while minimizing surgical trauma. To the authors’ knowledge, this represents one of the first reported cases of robotic-assisted DCRV repair. 

References

1. Ford DK, Bullaboy CA, Derkac WM, Hopkins RA, Jennings RB Jr, Johnson DH. Transatrial repair of double-chambered right ventricle. Ann Thorac Surg. 1988;46(4):412-415. doi:10.1016/s0003-4975(10)64654-1

Disclaimer

The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.