Open Access

ARTICLE

Role of Imaging in Surgical Decision Making for Patients with Double Outlet Right Ventricle

Shilpa Aryal^1,*, Marhisham Che Mood², Sivakumar Sivalingam², Boekhren Karyostyko², Yusoff Ramdzan², Haifa Abdul Latiff², Ming Chern Leong²

1 Clinical Research Department, Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia
2 Paediatric & Congenital Heart Centre, Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia

* Corresponding Author: Shilpa Aryal. Email:

(This article belongs to the Special Issue: Special Issue from the 5^th Asian Association for Pediatric and Congenital Heart Surgery (AAPCHS) Annual Conference)

Structural and Congenital Heart Disease 2026, 21(3), 5 https://doi.org/10.32604/schd.2026.083109

Received 29 March 2026; Accepted 21 July 2026; Issue published 31 July 2026

Abstract

Background: Double-outlet right ventricle (DORV) encompasses a spectrum of disorders characterized by both great vessels arising from the right ventricle. This study compared the diagnostic accuracy of multislice computed tomography (MSCT) and transthoracic echocardiography (TTE) in predicting the optimal surgical strategy by evaluating the concordance between preoperative imaging-based decisions and intraoperative findings. Methods: This single-center, retrospective study included 112 patients with DORV (56 MSCT + TTE and 56 TTE only) who underwent surgical correction between January 2010 and December 2024. Agreement between preoperative and intraoperative surgical decisions was assessed by weighted kappa (κ). Diagnostic accuracy was calculated using sensitivity, specificity, positive predictive value, and negative predictive value. Results: Median weight was 8.40 kg in the combined MSCT + TTE group and 9.56 kg in the TTE-only group. TTE demonstrated high concordance with intraoperative surgical findings (κ = 0.93), whereas the combined MSCT + TTE group demonstrated lower concordance (κ = 0.761). Macro average sensitivity and specificity were 95.8% and 98.8% for the TTE-only group, compared to 83.9% and 97.1% for the combined MSCT + TTE group. The lower concordance observed in the combined imaging group likely reflects the greater anatomical complexity of patients selectively referred for adjunctive MSCT imaging. Conclusions: TTE demonstrated stronger agreement with intraoperative surgical findings (κ = 0.93), whereas the combined MSCT + TTE group demonstrated lower concordance (κ = 0.761). The lower concordance observed in the combined imaging group likely reflects the greater anatomical complexity of patients selectively referred for adjunctive MSCT imaging.

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Keywords

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