Incidentally detected double-chambered right ventricle in an adult

Double-chambered right ventricle (DCRV) is a rare congenital cardiac anomaly caused by hypertrophy of right ventricular muscular structures, most commonly the moderator band, resulting in intracavitary obstruction and division of the right ventricle into high- and low-pressure chambers. It accounts for approximately 0.5%-2% of congenital heart diseases and is usually diagnosed in childhood, though delayed presentation in adulthood may occur. DCRV is frequently associated with other congenital anomalies and is often discovered on cardiac imaging. A 55-year-old asymptomatic woman was referred for cardiology evaluation due to a family history of thoracic aortic aneurysms. Physical examination revealed pectus excavatum and a cardiac murmur. Electrocardiography showed left ventricular hypertrophy with repolarization abnormalities. Transthoracic echocardiography identified right ventricular apical obstruction, prompting cardiac MRI. This demonstrated marked right ventricular hypertrophy and a prominent moderator band dividing the ventricle into proximal and distal chambers, consistent with type 1 DCRV. Cine imaging revealed a focal high-velocity jet at the obstruction site. The patient was referred for cardiology follow-up to consider surgical management, though this was not found to be necessary due to her being asymptomatic. DCRV is diagnostically challenging due to nonspecific or absent symptoms in adults. While echocardiography may detect obstructive flow, cardiac MRI is essential for detailed anatomical assessment and identification of associated anomalies. Early diagnosis is important, as guidelines recommend surgical intervention to prevent right ventricular dysfunction. DCRV may present in asymptomatic adults. This case highlights the value of advanced cardiac imaging in diagnosing atypical right ventricular obstruction and guiding timely management to prevent disease progression.