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Boyd R, Kalfa D, Nguyen S, Setton M, Shah A, Karamichalis J, Lewis M, Wassercug NZ, Rosenbaum M, Bacha E. Comparative outcomes and risk analysis after cone repair or tricuspid valve replacement for Ebstein's anomaly. JTCVS OPEN 2023; 14:372-384. [PMID: 37425446 PMCID: PMC10328840 DOI: 10.1016/j.xjon.2023.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 07/11/2023]
Abstract
Objective Ebstein's anomaly is a rare congenital heart malformation for which surgical and medical management are still controversial. The cone repair has transformed surgical outcomes in many of these patients. We aimed to present our results on the outcomes of patients with Ebstein's anomaly who underwent a cone repair or tricuspid valve replacement. Methods A total of 85 patients who underwent a cone repair (mean age, 16.5 years) or tricuspid valve replacement (mean age, 40.8 years) between 2006 and 2021 were included. Univariate, multivariate, and Kaplan-Meier analyses were used to evaluate operative and long-term outcomes. Results Residual/recurrent greater than mild-to-moderate tricuspid regurgitation at discharge was higher after cone repair compared with tricuspid valve replacement (36% vs 5%; P = .010). However, at last follow-up, the risk of greater than mild-to-moderate tricuspid regurgitation was not different between groups (35% in the cone group vs 37% in the tricuspid valve replacement group; P = .786). The tricuspid valve replacement group had a higher risk of tricuspid valve reoperation (37% vs 9%; P = .005) and tricuspid stenosis (21% vs 0%; P = .002) compared with the cone repair group. Kaplan-Meier freedom from reintervention was 97%, 91%, and 91% at 2, 4, and 6 years after cone repair, respectively, and 84%, 74%, and 68% at 2, 4, and 6 years after tricuspid valve replacement, respectively (P = .0191). At last follow-up, right ventricular function was significantly worse from baseline in the tricuspid valve replacement group (P = .0294). There were no statistical differences between age-stratified cohorts or surgeon volume in the cone repair group. Conclusions The cone procedure offers excellent results, with stable tricuspid valve function and low reintervention and death rates at last follow-up. The rate of greater than mild-to-moderate residual tricuspid regurgitation at discharge was higher after cone repair compared with tricuspid valve replacement, but this did not expose the patient to a higher risk of reoperation or death at last follow-up. Tricuspid valve replacement was associated with a significantly higher risk of tricuspid valve reoperation and tricuspid valve stenosis, and worse right ventricular function at last follow-up.
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Affiliation(s)
- Rebekah Boyd
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital New York-Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - David Kalfa
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital New York-Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Stephanie Nguyen
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital New York-Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Matan Setton
- Division of Pediatric Cardiology, Morgan Stanley Children Hospital New York-Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Amee Shah
- Division of Pediatric Cardiology, Morgan Stanley Children Hospital New York-Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - John Karamichalis
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital New York-Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Matthew Lewis
- Division of Cardiology, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Noa Zemer Wassercug
- Division of Cardiology, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Marlon Rosenbaum
- Division of Cardiology, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Emile Bacha
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital New York-Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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Alsaied T, Christopher AB, Da Silva J, Gupta A, Morell VO, Lanford L, Weinberg JG, Feingold B, Seery T, Hoskoppal A, Goldstein BH, Johnson JA, Olivieri LJ, De Fonseca Da Silva L. Multimodality Imaging in Ebstein Anomaly. Pediatr Cardiol 2023; 44:15-23. [PMID: 36151322 DOI: 10.1007/s00246-022-03011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/14/2022] [Indexed: 01/24/2023]
Abstract
Ebstein anomaly is the most common form of tricuspid valve congenital anomalies. The tricuspid valve is abnormal with different degrees of displacement of the septal leaflet and abnormal rotation of the valve towards the right ventricular outflow tract. In severe forms, it results in significant tricuspid regurgitation and requires surgical repair. There is an increased interest in understanding the anatomy of the tricuspid valve in this lesion as the surgical repair has evolved with the invention and wide adoption of the cone operation. Multimodality imaging plays an important role in diagnosis, follow-up, surgical planning and post-operative care. This review provides anatomical tips for the cardiac imagers caring for patients with Ebstein anomaly and will help provide image-based personalized medicine.
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Affiliation(s)
- Tarek Alsaied
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA.
| | - Adam B Christopher
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Jose Da Silva
- DaSilva Center of Ebstein Anomaly, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Cardiothoracic Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Aditi Gupta
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Victor O Morell
- DaSilva Center of Ebstein Anomaly, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Cardiothoracic Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lizabeth Lanford
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Jacqueline G Weinberg
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Brian Feingold
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Thomas Seery
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Arvind Hoskoppal
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Bryan H Goldstein
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Jennifer A Johnson
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Laura J Olivieri
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Luciana De Fonseca Da Silva
- DaSilva Center of Ebstein Anomaly, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Cardiothoracic Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Romberg EK, Stanescu AL, Bhutta ST, Otto RK, Ferguson MR. Computed tomography of pulmonary veins: review of congenital and acquired pathologies. Pediatr Radiol 2022; 52:2510-2528. [PMID: 34734315 DOI: 10.1007/s00247-021-05208-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/26/2021] [Accepted: 09/10/2021] [Indexed: 10/19/2022]
Abstract
Newer-generation CT scanners with ultrawide detectors or dual sources offer millisecond image acquisition times and significantly decreased radiation doses compared to historical cardiac CT and CT angiography. This technology is capable of nearly freezing cardiac and respiratory motion. As a result, CT is increasingly used for diagnosing and monitoring cardiac and vascular abnormalities in the pediatric population. CT is particularly useful in the setting of pulmonary vein evaluation because it offers evaluation of the entire pulmonary venous system and lung parenchyma. In this article we review a spectrum of congenital and acquired pulmonary venous abnormalities, including potential etiologies, CT imaging findings and important factors of preoperative planning. In addition, we discuss optimization of CT techniques for evaluating the pulmonary veins.
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Affiliation(s)
- Erin K Romberg
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - A Luana Stanescu
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Sadaf T Bhutta
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Randolph K Otto
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Mark R Ferguson
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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