{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:55:30Z","timestamp":1787507730276,"version":"build-2736575974"},"reference-count":31,"publisher":"BMJ","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorax"],"published-print":{"date-parts":[[1978,6,1]]},"DOI":"10.1136\/thx.33.3.283","type":"journal-article","created":{"date-parts":[[2008,12,12]],"date-time":"2008-12-12T22:15:45Z","timestamp":1229120145000},"page":"283-289","source":"Crossref","is-referenced-by-count":6,"title":["Double outlet right ventricle: clinical and anatomical spectrum."],"prefix":"10.1136","volume":"33","author":[{"given":"E K","family":"Weir","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H S","family":"Joffe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C N","family":"Barnard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W","family":"Beck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","reference":[{"key":"ref_1","article-title":"Sridaromont","author":"Mierop, Van; Wiglesworth, 1963, Hallermann","year":"1971","unstructured":"Van Mierop and Wiglesworth, 1963; Hallermann et al., 1970; Gomes et al., 1971 a, b; IKinsley et al., 1974; Zamora et al., 1975; Cameron et al., 1976; Sridaromont et al., 1976.","journal-title":"et al"},{"key":"ref_2","article-title":"1961 and 1962; Venables and","author":"Neufeld","year":"1966","unstructured":"Neufeld et al., 1961 and 1962; Venables and Campbell, 1966"},{"key":"ref_3","article-title":"Angelini and Leachman","author":"Witham","year":"1957","unstructured":"Witham, 1957; Angelini and Leachman, 1976"},{"key":"ref_4","author":"et a, Lev","year":"1972","unstructured":"Lev et a!., 1972"},{"key":"ref_5","article-title":"Shinebourne","author":"Kirklin","year":"1973","unstructured":"Kirklin et al., 1973; Shinebourne et al., 1976","journal-title":"et al"},{"key":"ref_6","article-title":"Mitral-aortic discontinuity Present Usually present Not necessary for diagnosis Not necessary for diagnosis Not necessary for diagnosis if the samples are drawn simultaneously from the great arteries. In our data eight patients were found at operation or from angiography to have subaortic VSD. The oxygen saturation in the aorta was higher than that in the pulmonary artery in six of these patients and was the same in two. Similarly, in one recent report, 27 patients had systemic arterial saturations higher than pulmonary arterial saturations (Sridaromont","year":"1976","unstructured":"Mitral-aortic discontinuity Present Usually present Not necessary for diagnosis Not necessary for diagnosis Not necessary for diagnosis if the samples are drawn simultaneously from the great arteries. In our data eight patients were found at operation or from angiography to have subaortic VSD. The oxygen saturation in the aorta was higher than that in the pulmonary artery in six of these patients and was the same in two. Similarly, in one recent report, 27 patients had systemic arterial saturations higher than pulmonary arterial saturations (Sridaromont et al., 1976). Twenty-four of these had subaortic ventricular septal defects. Thus when the aortic saturation is higher than the pulmonary arterial saturation the VSD is likely to be subaortic. Unfortunately, the reverse does not hold true, and when the pulmonary artery saturation is higher than the systemic saturation, the ventricular septal defect can be either subpulmonary or subaortic.","journal-title":"et al; Twenty-four of these had subaortic ventricular septal defects. Thus when the aortic saturation is higher than the pulmonary arterial saturation the VSD is likely to be subaortic. Unfortunately, the reverse does not hold true, and when the pulmonary artery saturation is higher than the systemic saturation, the ventricular septal defect can be either subpulmonary or subaortic"},{"key":"ref_7","article-title":"The electrocardiogram can sometimes alert the cardiologist to the possibility of DORV","author":"(Chesler et al.,","year":"1963","unstructured":"The electrocardiogram can sometimes alert the cardiologist to the possibility of DORV. Mirowski et al. (1963) described the electrocardiographic findings in patients with DORV associated with pulmonary stenosis. First-degree heart block was present in 42%, complete right bundle-branch block in 63%, and left ventricular hypertrophy in 74% (all of whom had systemic-to-pulmonary shunts). While these abnormalities are seldom seen in tetralogy of Fallot, the corresponding figures in our cases with pulmonary stenosis were 24%, 0%, and 6%. Consequently these particular features are not helpful in the differential diagnosis. Marked left axis deviation (mean - 1320) was present in 47% of our patients with pulmonary stenosis. Left axis deviation is exceptionally rare in tetralogy of Fallot (Chesler et al., 1972) and thus its presence should raise the suspicion of DORV. The electrocardiogram did not help to differentiate DORV without pulmonary stenosis from VSD.","journal-title":"Mirowski et al; described the electrocardiographic findings in patients with DORV associated with pulmonary stenosis. First-degree heart block was present in 42%, complete right bundle-branch block in 63%, and left ventricular hypertrophy in 74% (all of whom had systemic-to-pulmonary shunts). While these abnormalities are seldom seen in tetralogy of Fallot, the corresponding figures in our cases with pulmonary stenosis were 24%, 0%, and 6%. Consequently these particular features are not helpful in the differential diagnosis. Marked left axis deviation (mean - 1320) was present in 47% of our patients with pulmonary stenosis. Left axis deviation is exceptionally rare in tetralogy of Fallot"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1016\/S0002-9149(73)80014-1","article-title":"Pulmonary artery originating anteriorly from the left ventricle","volume":"32","author":"Angelini, P.; Leachman, R.D.","year":"1973","unstructured":"Angelini, P., and Leachman, R. D. (1973). Pulmonary artery originating anteriorly from the left ventricle. American Journal of Cardiology, 32, 840-845.","journal-title":"American Journal of Cardiology"},{"key":"ref_9","first-page":"127","article-title":"The spectrum of double outlet right ventricle: an embryologic interpretation","volume":"3","author":"Angelini, P.; Leachman, R.D.","year":"1976","unstructured":"Angelini, P., and Leachman, R. D. (1976). The spectrum of double outlet right ventricle: an embryologic interpretation. Cardiovascular Diseases. Bulletin of the Texas Heart Institute, 3, 127-149.","journal-title":"Cardiovascular Diseases. Bulletin of the Texas Heart Institute"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1136\/hrt.38.11.1124","article-title":"Double outlet right ventricle. Study of 27 cases","volume":"38","author":"Cameron, A.H.; Acerete, F.; Quero, M.; Castro, M.C.","year":"1976","unstructured":"Cameron, A. H., Acerete, F., Quero, M., and Castro, M. C. (1976). Double outlet right ventricle. Study of 27 cases. British Heart Journal, 38, 1124-1132.","journal-title":"British Heart Journal"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/0002-8703(72)90304-3","article-title":"Left anterior hemiblock and right bundle branch block before and after surgical repair of tetralogy of Fallot","volume":"84","author":"Chesler, E.; Beck, W.; Schrire, V.","year":"1972","unstructured":"Chesler, E., Beck, W., and Schrire, V. (1972). Left anterior hemiblock and right bundle branch block before and after surgical repair of tetralogy of Fallot. American Heart Journal, 84, 45-52.","journal-title":"American Heart Journal"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1161\/01.RES.18.6.625","article-title":"Spectrum of congenital cardiac anomalies produced in chick embryos by mechanical interference with cardiogenesis","volume":"18","author":"Gessner, I.H.","year":"1966","unstructured":"Gessner, I. H. (1966). Spectrum of congenital cardiac anomalies produced in chick embryos by mechanical interference with cardiogenesis. Circulation Research, 18, 625-633.","journal-title":"Circulation Research"},{"issue":"44","key":"ref_13","first-page":"31","article-title":"Double-outlet right ventricle without pulmonic stenosis","volume":"43","author":"Gomes, M.M.R.; Weidman, W.H.; McGoon, D.C.; Danielson, G.K.","year":"1971","unstructured":"Gomes, M. M. R., Weidman, W. H., McGoon, D. C., and Danielson, G. K. (1971a). Double-outlet right ventricle without pulmonic stenosis. Circulation, 43 and 44, Supplement 1, 31-36.","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1161\/01.CIR.43.6.889","article-title":"Double-outlet right ventricle with pulmonic stenosis","volume":"43","author":"Gomes, M.M.R.; Weidman, W.H.; McGoon, D.C.; Danielson, G.K.","year":"1971","unstructured":"Gomes, M. M. R., Weidman, W. H., McGoon, D. C., and Danielson, G. K. (1971b). Double-outlet right ventricle with pulmonic stenosis. Circulation, 43, 889-894.","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1161\/01.CIR.48.2.406","article-title":"The spectrum of transposition of the great arteries. With specific reference to the developmental anatomy of the conus","volume":"48","author":"Goor, D.A.; Edwards, J.E.","year":"1973","unstructured":"Goor, D. A., and Edwards, J. E. (1973). The spectrum of transposition of the great arteries. With specific reference to the developmental anatomy of the conus. Circulation, 48, 406-415.","journal-title":"Circulation"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"51","DOI":"10.2214\/ajr.109.1.51","article-title":"Angiocardiographic and anatomic findings in the origin of both great arteries from the right ventricle","volume":"109","year":"1970","unstructured":"Hallermann, F. J., Kincaid, 0. W., Ritter, D. G., Ongley, P. A., and Titus, J. L. (1970). Angiocardiographic and anatomic findings in the origin of both great arteries from the right ventricle. American Journal of Roentgenology, Radium Therapy and Nuclear Medicine, 109, 51-66.","journal-title":"American Journal of Roentgenology, Radium Therapy and Nuclear Medicine"},{"issue":"40","key":"ref_17","first-page":"207","article-title":"Double-outlet right ventricle with transposed great arteries and subpulmonary ventricular septal defect","volume":"39","author":"Hightower, B.M.; Barcia, A.; Barceron, L.M.; Kirklin, J.W.","year":"1969","unstructured":"Hightower, B. M., Barcia, A., Barceron, L. M., and Kirklin, J. W. (1969). Double-outlet right ventricle with transposed great arteries and subpulmonary ventricular septal defect. Circulation, 39 and 40, Supplement 1, 207-213.","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/S0022-5223(19)40513-8","article-title":"The surgical repair of positional anomalies of the conotruncus","volume":"67","author":"Kinsley, R.H.; Ritter, D.G.; McGoon, D.C.","year":"1974","unstructured":"Kinsley, R. H., Ritter, D. G., and McGoon, D. C. (1974). The surgical repair of positional anomalies of the conotruncus. Journal of Thoracic and Cardiovascular Surgery, 67, 395-403.","journal-title":"Journal of Thoracic and Cardiovascular Surgery"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1161\/01.CIR.48.1.153","article-title":"Cardiac repair in anatomically corrected malposition of the great arteries","volume":"48","author":"Kirklin, J.W.; Pacifico, A.D.; Bargeron, L.M.; Soto, B.","year":"1973","unstructured":"Kirklin, J. W., Pacifico, A. D., Bargeron, L. M., and Soto, B. (1973). Cardiac repair in anatomically corrected malposition of the great arteries. Circulation, 48, 153-159.","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/S0022-5223(19)41769-8","article-title":"A concept of double-outlet right ventricle","volume":"64","author":"Lev, M.; Bharati, S.; Meng, L.; Liberthson, R.R.; Paul, M.H.; Idriss, F.","year":"1972","unstructured":"Lev, M., Bharati, S., Meng, L., Liberthson, R. R., Paul, M. H., and Idriss, F. (1972). A concept of double-outlet right ventricle. Journal of Thoracic and Cardiovascular Surgery, 64, 271-281.","journal-title":"Journal of Thoracic and Cardiovascular Surgery"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1161\/01.CIR.28.6.1116","article-title":"The electrocardiogram in patients with both great vessels arising from the right ventricle combined with pulmonary stenosis","volume":"28","author":"Mirowski, M.; Mehrizi, A.; Taussig, H.B.","year":"1963","unstructured":"Mirowski, M., Mehrizi, A., and Taussig, H. B. (1963). The electrocardiogram in patients with both great vessels arising from the right ventricle combined with pulmonary stenosis. Circulation, 28, 1116-1127.","journal-title":"Circulation"},{"key":"ref_22","article-title":"Origin of both great vessels from the right ventricle","author":"Neufeld, H.N.; Dushane, J.W.; Wood, E.H.; Kirklin, J.W.; Edwards, J.E.","year":"1961","unstructured":"Neufeld, H. N., Dushane, J. W., Wood, E. H., Kirklin, J. W., and Edwards, J. E. (1961). Origin of both great vessels from the right ventricle."},{"key":"ref_23","first-page":"\"399","article-title":"Without pulmonary stenosis","volume":"23","author":"Neufeld, H.N.; Lucas, R.V.; Lester, R.G.; Adams, P.; Anderson, R.C.; Edwards, J.E.","year":"1962","unstructured":"Without pulmonary stenosis. Circulation, 23, 399-412. Neufeld, H. N., Lucas, R. V., Lester, R. G., Adams, P., Anderson, R. C., and Edwards, J. E. (1962). Origin of both great vessels from the right ventricle without pulmonary stenosis. British Heart Journal, 24, 393-408.","journal-title":"Circulation; Origin of both great vessels from the right ventricle without pulmonary stenosis"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1161\/01.CIR.54.2.298","article-title":"The normal spectrum of mitral and aortic valve discontinuity","volume":"54","author":"Rosenquist, G.G.; Clark, E.B.; Sweeney, L.J.; McAllister, H.A.","year":"1976","unstructured":"Rosenquist, G. G., Clark, E. B., Sweeney, L. J., and McAllister, H. A. (1976). The normal spectrum of mitral and aortic valve discontinuity. Circulation, 54, 298-301.","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1136\/hrt.38.4.327","article-title":"Sequential chamber localizationlogical approach to diagnosis in congenital heart disease","volume":"38","author":"Shineboume, E.A.; Macartney, J.; Anderson, R.H.","year":"1976","unstructured":"Shineboume, E. A., Macartney, J., and Anderson, R. H. (1976). Sequential chamber localizationlogical approach to diagnosis in congenital heart disease. British Heart Journal, 38, 327-340.","journal-title":"British Heart Journal"},{"key":"ref_26","first-page":"8594","article-title":"Double outlet right ventricle: hemodynamic and anatomic correlations","volume":"38","author":"Sridaromont, S.; Feldt, R.H.; Ritter, D.G.; Davis, G.D.; Edwards, J.E.","year":"1976","unstructured":"Sridaromont, S., Feldt, R. H., Ritter, D. G., Davis, G. D., and Edwards, J. E. (1976). Double outlet right ventricle: hemodynamic and anatomic correlations. American Journal of Cardiology, 38, 8594.","journal-title":"American Journal of Cardiology"},{"key":"ref_27","article-title":"Pathogenesis of transposition complexes","author":"Van Mierop, L.H.S.; Wiglesworth, F.W.","year":"1963","unstructured":"Van Mierop, L. H. S., and Wiglesworth, F. W. (1963). Pathogenesis of transposition complexes."},{"key":"ref_28","first-page":"874","article-title":"Anomalies due to faulty transfer of the posterior great artery","volume":"12","author":"226232. Van Praagh, R","year":"1973","unstructured":"Anomalies due to faulty transfer of the posterior great artery. American Journal of Cardiology, 12, 226232. Van Praagh, R. (1973). Do side by side great arteries merit a special name? American Journal of Cardiology, 32, 874-876.","journal-title":"American Journal of Cardiology; Do side by side great arteries merit a special name"},{"key":"ref_29","first-page":"461471","article-title":"Double outlet right ventricle. A review of 16 cases with 10 necropsy specimens","volume":"28","author":"Venables, A.W.; Campbell, P.E.","year":"1966","unstructured":"Venables, A. W., and Campbell, P. E. (1966). Double outlet right ventricle. A review of 16 cases with 10 necropsy specimens. British Heart Journal, 28, 461471.","journal-title":"British Heart Journal"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1016\/0002-8703(57)90329-0","article-title":"Double outlet right ventricle. A partial transposition complex","volume":"53","author":"Witham, A.C.","year":"1957","unstructured":"Witham, A. C. (1957). Double outlet right ventricle. A partial transposition complex. American Heart Journal, 53, 928-939.","journal-title":"American Heart Journal"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1378\/chest.68.5.672","article-title":"Double-outlet right ventricle. Anatomic types and associated anomalies","volume":"68","author":"Zamora, R.; Moller, J.H.; Edwards, J.E.","year":"1975","unstructured":"Zamora, R., Moller, J. H., and Edwards, J. E. (1975). Double-outlet right ventricle. Anatomic types and associated anomalies. Chest, 68, 672-677.","journal-title":"Chest"}],"container-title":["Thorax"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/thx.33.3.283","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,9,26]],"date-time":"2020-09-26T05:30:58Z","timestamp":1601098258000},"score":1,"resource":{"primary":{"URL":"https:\/\/thorax.bmj.com\/lookup\/doi\/10.1136\/thx.33.3.283"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1978,6,1]]},"references-count":31,"journal-issue":{"issue":"3","published-print":{"date-parts":[[1978,6,1]]}},"URL":"https:\/\/doi.org\/10.1136\/thx.33.3.283","relation":{},"ISSN":["0040-6376"],"issn-type":[{"value":"0040-6376","type":"print"}],"subject":[],"published":{"date-parts":[[1978,6,1]]}}}