Double outlet right ventricle (DORV) is a form of congenital heart disease where both of the great arteries connect (in whole or in part) to the right ventricle (RV). In some cases it is found that this occurs on the left side of the heart rather than the right side. Cause
Pathogenesis
DORV occurs in multiple forms, with variability of great artery position and size, as well as of ventricular septal defect (VSD) location. It can occur with or without transposition of the great arteries. The clinical manifestations are similarly variable, depending on how the anatomical defects affect the physiology of the heart, in terms of altering the normal flow of blood from the RV and left ventricle (LV) to the aorta and pulmonary artery. For example:
in DORV with a subaortic VSD, blood from the LV flows through the VSD to the aorta and blood from the RV flows mainly to the pulmonary artery, yielding physiology similar to ventricular septal defect
in DORV with a subpulmonic VSD (called Taussig-Bing syndrome), blood from the LV flows through the VSD to the pulmonary artery and blood from the RV flows mainly to the aorta, yielding physiology similar to Transposition of the Great Arteries
but if there is pulmonic stenosis in addition, physiology resembles Tetralogy of Fallot
in other forms of DORV, blood from both ventricles is substantially mixed in the RV, yielding physiology that resembles a large VSD
but again, if there is pulmonic stenosis, physiology resembles Tetralogy of Fallot

Treatment
DORV is treated with surgery.
spinipalpusm, Dermacentor andersoni, and D. variabilis
Endemic to: North America and eastern Russia
Colorado tick fever
Organism: Colorado tick fever virus (CTF), a coltivirus from the Reoviridae
Vector: Dermacentor andersoni
Region: US (West)
Crimean-Congo hemorrhagic fever
Organism: CCHF virus, a nairovirus, from the Bunyaviridae
Vector: Hyalomma marginatum, Rhipicephalus bursa
Region: Southern part of Asia, Northern Africa, Southern Europe
Severe febrile illnessOrganism: Heartland virus, a phlebovirus, from the Bunyaviridae
Vector: Lone star tick (Amblyomma americanum)
Region: Missouri and Tennessee, United States
Severe febrile illness, headaches, coma in 1/3 patientsOrganism: tentatively Alongshan virus, jingmenvirus group in the flavivirus family
Vector: tick (likely Ixodes persulcatus, Ixodes ricinus), mosquitoes
Region: Inner Mongolia but potentially more widespread

Protozoan
Babesiosis
Organism: Babesia microti, Theileria equi
Vector: Ixodes scapularis (deer tick), I. pacificus (western black-legged tick)
Region (US): Northeast, West Coast
Cytauxzoonosis
Organism: Cytauxzoon felis
Vector: Amblyomma americanum (Lone star tick)
Region (US): South, Southeast

Toxin
Tick paralysis
Cause: Toxin
Vector (US): Dermacentor andersoni (Rocky Mountain wood tick), D. variabilis (American dog tick or wood tick)
Region (US): D. andersoni: East, D. variabilis: East, West coast
Vector (Australia): Ixodes holocyclus (Australian paralysis tick)
Region (Australia): East

Allergies
Alpha-gal allergy - Alpha-gal syndrome is likely caused by a hypersensitivity reaction to the Alpha-gal (Galactose-alpha-1,3-galactose) sugar molecule introduced by ticks while feeding on a human host. The immune reaction can leave people with an allergy to red meat and other mammalian derived products.