Double chamber right ventricle (DCRV) repair surgery requires excision of anomalous obstructive muscular or fibromuscular bundles in the right ventricular outflow tract (RVOT). Owing to close proximity of key structures in the RVOT, the surgery is extremely challenging and requires precise resection. Under-resection of the muscle bands can lead to significant residual gradients in the post operative period, whereas over-enthusiastic resection can cause iatrogenic injury to surrounding structures. Various techniques like Hegar sizing by the surgeons, direct chamber pressure measurement, transesophageal echocardiography (TEE) and epicardial echocardiography can guide the surgeons about the adequacy of repair. TEE has a crucial role to play at each step as it can precisely determine the exact site of obstruction in the preoperative period. Postoperatively it is helpful in determining the adequacy of surgical repair and identification of inadvertent iatrogenic complications.
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