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Gupta A, Da Silva L, Wang L, Diaz-Castrillon CE, Dobson CP, Da Silva J, Olivieri LJ, Alsaied T, Christopher A. Assessing Left Ventricular Pathology in Patients with Ebstein Anomaly Using Cardiovascular Magnetic Resonance: Looking Past the Right Heart. Pediatr Cardiol 2024:10.1007/s00246-024-03585-8. [PMID: 39033244 DOI: 10.1007/s00246-024-03585-8] [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: 04/04/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024]
Abstract
Ebstein Anomaly (EA) is a malformation of the right heart, but there is data to suggest that the left ventricle (LV) can suffer from intrinsic structural and functional abnormalities which affect surgical outcomes. The LV in patients with EA is hypertrabeculated with abnormalities in LV function and strain. In this retrospective single-center study, patients with EA who underwent pre-operative cardiac MRI (CMR) between the periods of 2014-2024 were included along with a group of healthy-age-matched controls. Left ventricular and right ventricular volume, function and strain analyses were performed on standard SSFP imaging. LV noncompacted: compacted (NC/C) ratio and the displacement index of the tricuspid valve were measured. Forty-seven EA patients were included with mean age of 21.0 ± 17.6 years. Seventeen EA patients (36%) had mild pre-operative LV dysfunction on CMR and 1 (2.1%) had moderate LV dysfunction. Out of these 18 patients with LV dysfunction, only 2 were detected to have dysfunction on Echocardiogram. The global circumferential and longitudinal strain were significantly lower in the reduced LVEF group compared to those with preserved LVEF (- 14.8% vs. - 17%, p = 0.02 and - 11.9% vs. - 15.0%; p = 0.05; respectively) on CMR. A single EA patient met criteria for LVNC with a maximal NC/C ratio > 2.3. There was no statistically significant difference in NC/C ratio in the EA population (1.4 ± 0.6) vs. controls (1.1 ± 0.2), p = 0.17. There was an inverse correlation of LV ejection fraction with right ventricular end-diastolic volume and displacement index. All patients underwent the Da Silva Cone procedure at our center. Patients with preoperative LV dysfunction had longer duration of epinephrine use in the immediate postoperative period (33.7 ± 21.4 vs 10.2 ± 25.6 h, p = 0.02) and longer length of hospital stay (6.3 ± 3.2 vs 4.4 ± 1.2 days, p = 0.01). This is the largest study to date to evaluate preoperative LV structure and function in EA patients by CMR. In this cohort of 47 patients, preoperative LV dysfunction is fairly common and CMR has high sensitivity in detecting LV dysfunction as compared to Echo. True LV non-compaction was rare in this cohort. The presence of LV dysfunction is relevant to perioperative management and further study with larger cohorts and longer follow up are necessary.
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Affiliation(s)
- Aditi Gupta
- Division of Pediatric Cardiology, Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| | - Luciana Da Silva
- Division of Pediatric Cardiology, Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Da Silva Center for Ebstein anomaly, Pittsburgh, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Li Wang
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Carlos E Diaz-Castrillon
- Division of Pediatric Cardiology, Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Da Silva Center for Ebstein anomaly, Pittsburgh, PA, USA
| | - Craig P Dobson
- Division of Pediatric Cardiology, Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Jose Da Silva
- Division of Pediatric Cardiology, Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Da Silva Center for Ebstein anomaly, Pittsburgh, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Laura J Olivieri
- Division of Pediatric Cardiology, Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Tarek Alsaied
- Division of Pediatric Cardiology, Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam Christopher
- Division of Pediatric Cardiology, Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
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Wu Q, Zhang X, Zhang M, Li H, Zhang D, Wang L, Wu Q. Strategy and technique for surgical treatment of Ebstein's anomaly. Chin Med J (Engl) 2024; 137:1218-1224. [PMID: 38030389 PMCID: PMC11101237 DOI: 10.1097/cm9.0000000000002854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Ebstein's anomaly (EA) is a rare and complex congenital heart anomaly, and the effect of surgical treatment is not ideal. This study aims to introduce our experience in management strategies, surgical techniques, and operative indications for patients with Ebstein's anomaly. METHODS A retrospective study of 258 operations was performed in 253 patients by the same cardiac surgeon in The First Hospital of Tsinghua University between March 2004 and January 2020. 32 patients had previously received cardiac surgery in other hospitals. The clinical data including diagnosis, operative indications, techniques, pathological changes, and survival rates were collected and analyzed. RESULTS Anatomical correction was performed in 203 (78.7%) operations, 1½ ventricle repair in 38 (14.7%) operations, tricuspid valve repair only in four operations (1.6%), tricuspid valve replacement in ten (3.9%), total cavopulmonary connection (TCPC) in two (0.8%), and Glenn operation in one operation (0.4%). Reoperation was performed in five patients (2.0%) during hospitalization. Among them, tricuspid valve replacement was performed in one patient, 1½ ventricle repair in two patients, and tricuspid valve annulus reinforcement in two patients. Five patients died with an early mortality rate of 2.0%. Complete atrioventricular conduction block was complicated in one patient (0.4%). A total of 244 patients was followed up (four in the 253 patients lost) with a duration of 3.0-168.0 (87.6 ± 38.4) months. Cardiac function of 244 patients improved significantly with mean New York Heart Association (NYHA) functional class recovery from 3.5 to 1.1. The mean grade of tricuspid valve regurgitation improved from 3.6 to 1.5. Three late deaths (1.2%) occurred. The survival rates at five and ten years after surgery were 98.6% and 98.2%, respectively. Reoperation was performed in five patients (2.0%) during the follow-up period. CONCLUSION Based on our management strategies and operative principles and techniques, anatomical correction of EA is capable of achieving excellent long-term results, and low rates of TCPC, 1½ ventricle repair and valvular replacement.
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Affiliation(s)
- Qingyu Wu
- Cardiac Center, Division of Cardiac Surgery, The First Hospital of Tsinghua University, Beijing 100016, China
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Liu X, Gao Y, Wang Z, Shi R, Qian WL, Shen MT, Sun YS, Yang ZG. Effect of concomitant atrial septal defect on left ventricular function in adult patients with unrepaired Ebstein's anomaly: a cardiovascular magnetic resonance imaging study. J Cardiovasc Magn Reson 2023; 25:75. [PMID: 38057914 PMCID: PMC10702047 DOI: 10.1186/s12968-023-00976-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/10/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Due to the heterogeneity of anatomic anomalies in Ebstein's anomaly (EA), particularly in the subset of patients with atrial septal defect (ASD), hemodynamic changes, which ultimately cause left ventricular (LV) deterioration remain unclear. The current study aimed to investigate the effect of concomitant ASD on LV function using cardiovascular magnetic resonance (CMR) imaging in patients with EA. METHODS This study included 31 EA patients with ASD, 76 EA patients without ASD, 35 patients with simple ASD and 40 healthy controls. Left/right ventricular (RV, the RV was defined as a summation of the functional RV and atrialized RV in EA patients) volumes and functional parameters, LV strain parameters, and echocardiogram indices were compared among the four groups. Associations between variables were evaluated via Spearman or Pearson correlation analyses. The association between risk factors and LV ejection fraction (EF) was determined via multivariate linear regression analysis. RESULTS Both EA patients and ASD patients had a higher RV/LV end-diastolic volume (RVEDV/LVEDV) as well as lower LV and RV ejection fractions (LVEF/RVEF) compared to healthy controls (all p < 0.05). Moreover, the EA patients with ASD had a significantly higher RVEDV/LVEDV and a lower LVEF and RVEF than those without ASD (all p < 0.05). Multivariate linear regression analysis revealed that the presence of ASD was independently associated with LVEF (β = - 0.337, p < 0.001). The RVEDV/LVEDV index was associated with LVEF (r = - 0.361, p < 0.001). Furthermore, the LV longitudinal peak diastolic strain rate (PDSR) was lower in EA patients with ASD than those without ASD, patients with simple ASD, and healthy controls (p < 0.05). CONCLUSION Concomitant ASD is an important risk factor of LV dysfunction in patients with EA, and diastolic dysfunction is likely the predominate mechanism related to LV dysfunction.
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Affiliation(s)
- Xi Liu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, 52# Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhen Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, 52# Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Rui Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wen-Lei Qian
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Meng-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, 52# Fu Cheng Road, Hai Dian District, Beijing, 100142, China.
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Van Praagh R. Tricuspid Valve Anomalies. CONGENIT HEART DIS 2022. [DOI: 10.1016/b978-1-56053-368-9.00013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zhang H, Hua X, Song J. Phenotypes of Cardiovascular Diseases: Current Status and Future Perspectives. PHENOMICS (CHAM, SWITZERLAND) 2021; 1:229-241. [PMID: 36939805 PMCID: PMC9590492 DOI: 10.1007/s43657-021-00022-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
Cardiovascular diseases (CVDs) are a large group of diseases and have become the leading cause of morbidity and mortality worldwide. Although considerable progresses have been made in the diagnosis, treatment and prognosis of CVD, communication barriers between clinicians and researchers still exist because the phenotypes of CVD are complex and diverse in clinical practice and lack of unity. Therefore, it is particularly important to establish a standardized and unified terminology to describe CVD. In recent years, there have been several studies, such as the Human Phenotype Ontology, attempting to provide a standardized description of the disease phenotypes. In the present article, we outline recent advances in the classification of the major types of CVD to retrospectively review the current progresses of phenotypic studies in the cardiovascular field and provide a reference for future cardiovascular research.
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Affiliation(s)
- Hang Zhang
- grid.506261.60000 0001 0706 7839The Cardiomyopathy Research Group, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, 100037 China
| | - Xiumeng Hua
- grid.506261.60000 0001 0706 7839The Cardiomyopathy Research Group, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, 100037 China
| | - Jiangping Song
- grid.506261.60000 0001 0706 7839The Cardiomyopathy Research Group, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, 100037 China
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Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Iung B, Kluin J, Lang IM, Meijboom F, Moons P, Mulder BJ, Oechslin E, Roos-Hesselink JW, Schwerzmann M, Sondergaard L, Zeppenfeld K, Ernst S, Ladouceur M, Aboyans V, Alexander D, Christodorescu R, Corrado D, D’Alto M, de Groot N, Delgado V, Di Salvo G, Dos Subira L, Eicken A, Fitzsimons D, Frogoudaki AA, Gatzoulis M, Heymans S, Hörer J, Houyel L, Jondeau G, Katus HA, Landmesser U, Lewis BS, Lyon A, Mueller CE, Mylotte D, Petersen SE, Petronio AS, Roffi M, Rosenhek R, Shlyakhto E, Simpson IA, Sousa-Uva M, Torp-Pedersen CT, Touyz RM, Van De Bruaene A. Guía ESC 2020 para el tratamiento de las cardiopatías congénitas del adulto. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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7
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Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Lung B, Kluin J, Lang IM, Meijboom F, Moons P, Mulder BJM, Oechslin E, Roos-Hesselink JW, Schwerzmann M, Sondergaard L, Zeppenfeld K. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J 2021; 42:563-645. [PMID: 32860028 DOI: 10.1093/eurheartj/ehaa554] [Citation(s) in RCA: 864] [Impact Index Per Article: 288.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Abstract
Ebstein’s anomaly (EA) is a rare congenital cardiac anomaly. It is a disease at a minimum of the tricuspid valve (TV) and the right ventricular myocardium. Presentation varies from a severe symptomatic form during the neonatal period to an incidental detection later in life due to the wide morphological variation of the condition. The neonatal presentation can be severe and every attempt should be made at medical management ideally into infancy and early childhood. Neonates not eligible or failing medical management should be surgically managed either with a single ventricle palliative approach or a more desirable biventricular repair with a neonatal TV valvuloplasty. Some neonates initially committed to a single ventricle pathway may be converted to a biventricular repair by a delayed TV valvuloplasty. The da Silva Cone repair has become the valvuloplasty of choice especially beyond the neonatal period and can be applied to a wide morphological variation of the condition with good long-term durability. If the chance of a successful TV valvuloplasty is high, it should be offered early in childhood to prevent further cardiac dilation. Adding a Bidirectional Glenn to a valvuloplasty may help salvage marginal risk patients or marginally repairable valves. If valve replacement is the only option, a bioprosthetic valve should be used as it is less thrombogenic especially with marginal right ventricular function. Heart transplantation should be considered in patients with associated left ventricular dysfunction.
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Affiliation(s)
- Sandeep Sainathan
- Department of Surgery, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | | | - Jose Pedro da Silva
- Department of Cardio-thoracic surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Ozbek B, Tanrikulu N. Cone Type Repair Has Become Our First Option in the Treatment of Adult Ebstein Anomaly. Ann Thorac Cardiovasc Surg 2019; 25:260-264. [PMID: 31308306 PMCID: PMC6823174 DOI: 10.5761/atcs.oa.18-00309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Different surgical procedures were defined due to degree of Ebstein anomaly. In this study, we are reporting our surgical experience of adult patients with Ebstein anomaly. METHODS We analyzed the patients, who had operated with the diagnosis of Ebstein anomaly from March 2011 through February 2018, retrospectively. We evaluated patients in two groups: patients with cone type surgical repair were in Group 1 and patients with other surgical (Danielson, Carpentier) procedures were in Group 2. RESULTS There were 23 patients in the study; 9 (39%) were in Group 1 and 14 (61%) were in Group 2. In the comparison of preoperative data, groups were statistically similar. Aortic cross clamp and cardiopulmonary bypass (CPB) times, need for inotropic agents, intubation time, postoperative >2 tricuspid regurgitation incidence, intensive care unit, and hospital staying times were statistically significantly higher in Group 2. There was one mortality (4.3%) in Group 2 due to sepsis. CONCLUSION Cone type repair can safely be performed in the repair of Ebstein anomaly with acceptable results. Our results are encouraging to prefer this technique as one of the first-line treatment of Ebstein anomaly. However, further randomized controlled studies are recommended to evaluate the efficacy of this surgical procedure.
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Affiliation(s)
- Baburhan Ozbek
- Van Training and Research Hospital, Department of Pediatric Cardiovascular Surgery, Van, Turkey
| | - Nursen Tanrikulu
- Kolan International Hospital, Department of Anesthesiology, Istanbul, Turkey
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Koc L, Ondrášek J, Zatočil T, Nečasová A, Špinar J. Ebstein's anomaly with significant dysplasia of the tricuspid valve presenting at 73 years of age. A case report. COR ET VASA 2019. [DOI: 10.1016/j.crvasa.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mid-term outcomes of individualized surgeries in patients with Ebstein's anomaly. Heart Vessels 2019; 34:1332-1339. [PMID: 30848337 DOI: 10.1007/s00380-019-01358-5] [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: 10/09/2018] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
The variable anatomy of Ebstein's anomaly leads to its various surgical procedures. The long-term outcomes of different operations were not well established. Thirty-five patients with Ebstein's anomaly who underwent operations from 2006 to 2018 in our department were retrospectively reviewed. Individualized surgical plans were performed according to the preoperative echocardiography and surgeons' preference. Tricuspid repair, either Danielson's or Carpentier's technique, was the primary choice in patients who had sufficient tricuspid leaflets and adequate right ventricle, while tricuspid replacement was used when a reliable repair is not achievable. Additional bidirectional cavopulmonary shunt was performed in those who had unstable hemodynamics despite of high central venous pressure after separation from cardiopulmonary bypass. The perioperative and follow-up data were collected. The age was 26.9 (0.6-54) years [16 children (age < 14, and 19 adults (age ≥ 14)]. Preoperative tricuspid regurgitation was severe in 30, moderate in 4, and mild in the remaining 1 patient. Preoperative cardiac-associated malformations include 20 atrial septal defects, 2 ventricular septal defects, 2 pulmonary stenosis, and 1 sub aortic ridge, and these were operated simultaneously. Among all the surgical patients, 2 needed additional reoperation during the same admission, and ultimately, 29 patients had biventricular repair, including 21 tricuspid repair and 8 replacements. The other 6 patients had cavopulmonary connection and achieved 1.5 ventricular repair (3 tricuspid repair and 3 replacements). In all the 24 tricuspid repair patients, Danielson's procedure was used in 17, while Carpentier's technique was used in the other 7 patients. The average cardiopulmonary bypass time was 90 ± 28 min and cross-clamp time was 48 ± 24min. There were 2 perioperative deaths (5.7%) and no third-degree atrioventricular block. The postoperative in hospital stay was 13.7 ± 9.6 days. In the 33 survivors who were followed up at a median of 29.2 months, 6 patients had severe tricuspid regurgitation, and 2 of them underwent tricuspid replacement. The 5-year freedom from severe tricuspid dysfunction or reoperation was 78.5%, and no difference was found between children and adults, neither between different surgical choices. The surgeries of Ebstein's anomaly were variable, and individualized operation achieved reasonable short- and mid-term results. However, severe tricuspid regurgitation during the follow-up was not neglectable, and reoperation in such cases also achieved good outcomes. New repair strategy such as cone repair may be considered.
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Malhotra A, Agrawal V, Patel K, Shah M, Sharma K, Sharma P, Siddiqui S, Oswal N, Pandya H. Ebstein's Anomaly: "The One and a Half Ventricle Heart". Braz J Cardiovasc Surg 2019; 33:353-361. [PMID: 30184032 PMCID: PMC6122759 DOI: 10.21470/1678-9741-2018-0100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/03/2018] [Indexed: 12/05/2022] Open
Abstract
Objective Ebstein's anomaly remains a relatively ignored disease. Lying in the 'No
Man's land' between congenital and valve surgeons, it largely remains
inadequately studied. We report our short-term results of treating it as a
'one and a half ventricle heart' and propose that the true tricuspid annulus
(TTA) 'Z' score be used as an objective criterion for estimation of
'functional' right ventricle (RV). Methods 22 consecutive patients undergoing surgery for Ebstein's anomaly were
studied. Echocardiography was performed to assess the type and severity of
the disease, tricuspid annular dimension and its 'Z' score. Patients were
operated by a modification of the cone repair, with addition of
annuloplasty, bidirectional cavopulmonary shunt (BCPS) and right reduction
atrioplasty to provide a comprehensive repair. TTA 'Z' score was correlated
later with postplication indexed residual RV volume. Results There was one (4.5%) early and no late postoperative death. There was a
significant reduction in tricuspid regurgitation grading (3.40±0.65
to 1.22±0.42, P<0.001). Residual RV volume
reduced to 71.96±3.8% of the expected volume and there was a
significant negative correlation (rho −0.83) between TTA 'Z' score and
indexed residual RV volume. During the follow-up of 20.54±7.62
months, the functional class improved from 2.59±0.7 to
1.34±0.52 (P<0.001). Conclusion In Ebstein's anomaly, a higher TTA 'Z' score correlates with a lower
postplication indexed residual RV volume. Hence, a complete trileaflet
repair with offloading of RV by BCPS (when the TTA 'Z' score is >2) is
recommended. The short-term outcomes of our technique are promising.
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Affiliation(s)
- Amber Malhotra
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Centre (affiliated to BJ medical college, Ahmedabad), Gujarat, India
| | - Vishal Agrawal
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Centre (affiliated to BJ medical college, Ahmedabad), Gujarat, India
| | - Kartik Patel
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Centre (affiliated to BJ medical college, Ahmedabad), Gujarat, India
| | - Mausam Shah
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Centre (affiliated to BJ medical college, Ahmedabad), Gujarat, India
| | - Kamal Sharma
- Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (affiliated to BJ medical college, Ahmedabad), Gujarat, India
| | - Pranav Sharma
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Centre (affiliated to BJ medical college, Ahmedabad), Gujarat, India
| | - Sumbul Siddiqui
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Centre (affiliated to BJ medical college, Ahmedabad), Gujarat, India
| | - Nilesh Oswal
- Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (affiliated to BJ medical college, Ahmedabad), Gujarat, India
| | - Himani Pandya
- Department of Research, U. N. Mehta Institute of Cardiology and Research Centre (affiliated to BJ medical college, Ahmedabad), Gujarat, India
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Yang D, Li X, Sun JY, Cheng W, Greiser A, Zhang TJ, Liu H, Wan K, Luo Y, An Q, Chung YC, Han Y, Chen YC. Cardiovascular magnetic resonance evidence of myocardial fibrosis and its clinical significance in adolescent and adult patients with Ebstein's anomaly. J Cardiovasc Magn Reson 2018; 20:69. [PMID: 30257686 PMCID: PMC6158838 DOI: 10.1186/s12968-018-0488-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/05/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Myocardial fibrosis is a common pathophysiological process that is related to ventricular remodeling in congenital heart disease. However, the presence, characteristics, and clinical significance of myocardial fibrosis in Ebstein's anomaly have not been fully investigated. This study aimed to evaluate myocardial fibrosis using cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) and T1 mapping techniques, and to explore the significance of myocardial fibrosis in adolescent and adult patients with Ebstein's anomaly. METHODS Forty-four consecutive patients with unrepaired Ebstein's anomaly (34.0 ± 16.2 years; 18 males), and an equal number of age- and gender-matched controls, were included. A comprehensive CMR protocol consisted of cine, LGE, and T1 mapping by modified Look-Locker inversion recovery (MOLLI) sequences were performed. Ventricular functional parameters, native T1, extracellular volume (ECV), and LGE were analyzed. Associations between myocardial fibrosis and disease severity, ventricular function, and NYHA classification were analyzed. RESULTS LGE was found in 10 (22.7%) patients. Typical LGE in Ebstein's anomaly was located in the endocardium of the septum within the right ventricle (RV). The LV ECV of Ebstein's anomaly were significantly higher than those of the controls (30.0 ± 3.8% vs. 25.3 ± 2.3%, P < 0.001). An increased ECV was found to be independent of the existence of LGE. Positive LGE or higher ECV (≥30%) was associated with larger fRV volume, aRV volume, increased disease severity, and worse NYHA functional class. In addition, ECV was significantly correlated with the LV ejection fraction (P < 0.001). CONCLUSIONS Both focal and diffuse myocardial fibrosis were observed in adolescent and adult patients with Ebstein's anomaly. Increased diffuse fibrosis is associated with worse LV function, increased Ebstein's severity, and worse clinical status.
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Affiliation(s)
- Dan Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province China
| | - Xiao Li
- Department of Cardiovascular Surgery/Pediatric Heart Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province China
| | - Jia-Yu Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province China
| | - Wei Cheng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province China
| | | | - Tian-Jing Zhang
- Northeast Asia MR Collaboration, Siemens Healthcare, Beijing, China
| | - Hong Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province China
| | - Ke Wan
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province China
| | - Yong Luo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province China
| | - Qi An
- Department of Cardiovascular Surgery/Pediatric Heart Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province China
| | - Yiu-Cho Chung
- Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Key Laboratory for MRI, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong China
| | - Yuchi Han
- Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, PA USA
| | - Yu-Cheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province China
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Holst KA, Dearani JA, Said S, Pike RB, Connolly HM, Cannon BC, Sessions KL, O'Byrne MM, O'Leary PW. Improving Results of Surgery for Ebstein Anomaly: Where Are We After 235 Cone Repairs? Ann Thorac Surg 2017; 105:160-168. [PMID: 29174783 DOI: 10.1016/j.athoracsur.2017.09.058] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 09/14/2017] [Accepted: 09/20/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ebstein anomaly has heterogeneous anatomy and numerous operative techniques are described. Cone repair provides a near anatomic tricuspid valve repair. The purpose of this study was to examine our experience with cone repair. METHODS Cone repair was performed in 235 consecutive patients with Ebstein anomaly, 134 children (57%) and 101 adults (43%), from June 2007 to October 2015. Median age was 15.6 years (range, 6 months to 73 years). Cone repair was the first operation in 192 patients (82%), the second in 41 (17%), and the third in 2 (1%). Previous tricuspid valve repair had been performed in 27 (12%). Echocardiograms were obtained preoperatively and at hospital dismissal for all patients and for a subgroup of patients at least 6 months after cone repair (n = 81). RESULTS Leaflet augmentation was done in 67 patients (28%), Sebening stitch in 57 (24.2%), neochordae in 49 (21%), and annuloplasty band in 158 (67%). Bidirectional cavopulmonary shunt was performed in 46 patients (20%). There was 1 early death (0.4%). Early reoperation was required in 14 patients (5.9%); re-repair was possible in 7 (50%). The majority of early reoperations (11 of 14; 79%) occurred in the first third of the series. Mean follow-up was 3.5 ± 2.5 years. There was sustained reduction in tricuspid regurgitation (p < 0.0001), a progressive decline in right ventricle size (p < 0.0001), and late increase in right ventricle fractional area change after initial decline (p < 0.0001). Freedom from late reoperation was 97.9% at 6 years. CONCLUSIONS Cone repair is safe, and the learning curve is significant. Sustained reduction in tricuspid regurgitation and favorable changes in the right ventricle at follow-up suggest that cone repair has an advantageous impact on right ventricular remodeling.
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Affiliation(s)
- Kimberly A Holst
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
| | - Sameh Said
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Roxann B Pike
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | - Heidi M Connolly
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Bryan C Cannon
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | | | - Megan M O'Byrne
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Yuan SM. Ebstein's Anomaly: Genetics, Clinical Manifestations, and Management. Pediatr Neonatol 2017; 58:211-215. [PMID: 28017577 DOI: 10.1016/j.pedneo.2016.08.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/17/2016] [Accepted: 08/06/2016] [Indexed: 10/20/2022] Open
Abstract
Ebstein's anomaly is uncommon. Genetic bases of this congenital heart defect may be related to the mutations in myosin heavy chain 7 and NKX2.5, among others. Asymptomatic patients with Ebstein's anomaly can be conservatively treated and kept under close follow-up, whereas surgical operation is indicated for those patients with evidence of right heart dilation and progressively impaired ventricular systolic function. A biventricular repair consisting of the reconstruction of a competent monocuspid tricuspid valve, right ventriculorrhaphy, subtotal atrial septal defect closure, and aggressive reduction atrioplasty is suitable for most patients, and 1.5-ventricular repair (bidirectional Glenn shunt) is indicated for patients with poor right ventricular function; by contrast, heart transplantation is used in patients with severe left ventricular dysfunction.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian 351100, Fujian Province, People's Republic of China.
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Belli E, Rabot M, Petit J, Gouton M. Ebstein's anomaly in adults: Modified cone reconstruction of the tricuspid valve is associated with promising outcomes. Arch Cardiovasc Dis 2017; 110:325-333. [DOI: 10.1016/j.acvd.2017.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
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Luo M, Lin J, Qin Z, Du L. Prevention preferable to treatment: 3 case reports of patients experiencing right-sided heart failure after Ebstein anomaly correction. Medicine (Baltimore) 2017; 96:e5627. [PMID: 28072699 PMCID: PMC5228659 DOI: 10.1097/md.0000000000005627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Ebstein anomaly is a common congenital heart disease that may induce severe tricuspid regurgitation and dilation of the "atrialized" portion of the right ventricle. Patients who undergo surgery to correct Ebstein anomaly are at high risk of postoperative right-sided heart failure, yet little is known about what pre-, peri-, or postoperative procedures may help reduce this risk. PATIENT CONCERNS Here, we describe 3 cases of adults with Ebstein anomaly who underwent corrective surgery and in whom right-sided heart failure occurred with severe tricuspid regurgitation detected by transesophageal echocardiography. DIAGNOSES Ebstein anomaly. INTERVENTION Various approaches were applied to prevent right heart failure: perioperative control of atrial and ventricle arrhythmia, protection of myocardium, reduction of right-side cardiac workload after cardiopulmonary bypass, and mechanical support for right heart. OUTCOMES One of the 3 patients died, another experienced kidney failure despite postoperative support on extracorporeal membrane oxygenation, and the third patient survived without complications. LESSONS Our case series suggests that surgical prognosis can be improved through aggressive preoperative treatment, vasoactive and anti-arrhythmia medications, and comprehensive measures designed to reduce myocardial injury, prevent myocardial edema, and reduce pre- and afterload on the right ventricle.
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Galea J, Ellul S, Schembri A, Schembri-Wismayer P, Calleja-Agius J. Ebstein anomaly: a review. Neonatal Netw 2016; 33:268-74. [PMID: 25161135 DOI: 10.1891/0730-0832.33.5.268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cardiac congenital abnormalities are a leading cause in neonatal mortality occurring in up to 1 in 200 of live births. Ebstein anomaly, also known as Kassamali anomaly, accounts for 1 percent of all congenital cardiac anomalies. This congenital abnormality involves malformation of the tricuspid valve and of the right ventricle. In this review, the causes of the anomaly are outlined and the pathophysiology is discussed, with a focus on the symptoms, management, and treatments available to date.
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Im YM, Park CS, Park JJ, Yun TJ. Restoration of Tricuspid Valve Mechanism at the Level of Displaced Septal and Posterior Leaflets in Ebstein's Anomaly. J Card Surg 2016; 31:168-73. [PMID: 26805702 DOI: 10.1111/jocs.12689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgical techniques currently used for the repair of Ebstein's anomaly comprise reconstruction of the tricuspid valve mechanism at the level of the true annulus with or without plication of the atrialized right ventricle. However, performing this procedure for patients with a dysmorphic anterior leaflet (i.e., insufficient leaflet tissue and decreased mobility due to tethering) may necessitate technical modifications. METHODS A retrospective review was performed of 31 patients (seven males and 24 females, median age at operation 31 years) with Ebstein's anomaly, who underwent tricuspid valve repair between March 2002 and December 2014. The original Hetzer technique (annulus to annulus approximation) was employed for six patients with a well-formed anterior leaflet. In 25 patients, the tricuspid valve mechanism was restored at the displaced septal leaflet by approximating the anterior leaflet attachment in the true annulus to the displaced septal leaflet attachment in the mid-septum. A bidirectional superior cavopulmonary anastomosis was added in 27 of 31 (87%) patients. RESULTS No early or late death occurred during the median follow-up of 66 months (1-138 months). Immediate postoperative tricuspid regurgitation was trivial to mild in 22 patients, and the median preoperative, immediate postoperative, and last follow-up tricuspid regurgitation jet areas in 21 adult patients were 23.3 cm2, 10.4 cm2, and 7.0 cm2, respectively. Two patients underwent reoperation at 81 and 119 months postoperatively. Five-year freedom from severe tricuspid regurgitation or reoperation was 93.2%. CONCLUSION Restoration of the tricuspid valve mechanism at the level of displaced septal leaflet leads to excellent long-term outcomes. The addition of the bidirectional superior cavopulmonary anastomosis has contributed to the success of this technique.
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Affiliation(s)
- Yu-Mi Im
- Seoul Women's College of Nursing, Seoul, Republic of Korea
| | - Chun Soo Park
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong-Jun Park
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae-Jin Yun
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Morray B. Preoperative Physiology, Imaging, and Management of Ebstein's Anomaly of the Tricuspid Valve. Semin Cardiothorac Vasc Anesth 2015; 20:74-81. [PMID: 26620137 DOI: 10.1177/1089253215616499] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ebstein's anomaly of the tricuspid valve (TV) refers to an embryological derangement of TV formation causing tethering of the septal and posterior leaflets of the valve to the underlying myocardium and apical displacement of the effective valve annulus, resulting in significant TV insufficiency and dilation of the right heart structures. The pathological abnormalities of the valve can vary significantly, resulting in a wide range of clinical presentations. Fetal diagnosis and neonatal presentations of the disease are typically the most severe and are associated with the highest mortality rates. Patients with less-severe disease will present later in life with symptoms of right heart failure and tachyarrhythmias. Medical and surgical management strategies are driven by the age at presentation, severity of disease, and any associated cardiac abnormalities. There are an increasing number of surgical options focused on valve repair.
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Ibrahim M, Tsang VT, Caruana M, Hughes ML, Jenkyns S, Perdreau E, Giardini A, Marek J. Cone reconstruction for Ebstein's anomaly: Patient outcomes, biventricular function, and cardiopulmonary exercise capacity. J Thorac Cardiovasc Surg 2015; 149:1144-50. [DOI: 10.1016/j.jtcvs.2014.12.074] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 12/17/2014] [Accepted: 12/25/2014] [Indexed: 11/28/2022]
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Booker OJ, Nanda NC. Echocardiographic assessment of Ebstein's anomaly. Echocardiography 2014; 32 Suppl 2:S177-88. [PMID: 24888693 DOI: 10.1111/echo.12486] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Ebstein's anomaly is a complex congenital lesion which primarily involves the tricuspid valve. The tricuspid leaflets are tethered to varying degrees to the right ventricular free wall and the ventricular septum often resulting in significant tricuspid regurgitation and a small functioning right ventricular chamber. Although the septal leaflet originates normally at the right atrioventricular junction, the proximal portion is often completely tethered to the ventricular septum resulting in a misconception and erroneous statements in many publications that its attachment is apically displaced. Although two-dimensional echocardiography represents the primary modality for the diagnosis of this anomaly, three-dimensional echocardiography provides incremental value in characterizing the extent and severity of tethering of individual tricuspid valve leaflets. This information is useful in surgical decision making whether to repair or replace the tricuspid valve.
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Affiliation(s)
- Oscar J Booker
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
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24
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Nguyen HS, Vu TD, Nguyen TQ. A Modified Carpentier's Technique for Ebstein's Anomaly Repair. J Card Surg 2014; 29:554-60. [DOI: 10.1111/jocs.12364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Thang Duc Vu
- Department of Surgery, Hospital 103; Vietnam Military Medical University; Hanoi Vietnam
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Wu Q, Pan G, Li H, Kong X. Anatomic repair of Ebstein's anomaly with isolated anterior leaflet downward displacement. J Thorac Cardiovasc Surg 2014; 148:1454-1458.e1. [PMID: 24698561 DOI: 10.1016/j.jtcvs.2014.02.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 02/21/2014] [Accepted: 02/26/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Ebstein's anomaly with isolated anterior leaflet downward displacement is rare and has not been reported in the literature to our knowledge. In this article, our experience of the surgical treatment in 6 cases with this anomaly is reported. METHODS From November 2005 to November 2013, 6 patients (3 male, 3 female, aged 2-39 years) with Ebstein's anomaly and isolated anterior leaflet downward displacement received anatomic repair at the First Hospital of Tsinghua University. The diagnosis was made by echocardiography and confirmed at operation. Surgery was performed under hypothermic cardiopulmonary bypass. Surgical technique included excision of a huge atrialized portion of the right ventricle located in the anterior wall of the heart; reconstruction of the right ventricle by repairing the "V"-shaped defect left by the excision procedure; detachment, repair, and reimplantation of the anterior leaflet; and reconstitution of the right atrioventricular connection. Intraoperative transesophageal echocardiography was used to evaluate the position, morphology, structure, and function of the tricuspid valve, as well as right ventricular function. RESULTS Five patients were discharged uneventfully, and 1 patient died of postoperative pneumonia. At follow-up from 2 months to 7 years, no notable tricuspid valve regurgitation or stenosis was found and all patients were maintaining a normal lifestyle. The 27-year-old female patient gave birth to a normal infant uneventfully 3 years after surgery. CONCLUSIONS Ebstein's anomaly with isolated anterior leaflet downward displacement is a complex and severe abnormality, and has several unique anatomic and clinical features and specific surgical requirements. Preoperative diagnosis can be made by clinical investigation and echocardiography. Excellent results can be achieved by anatomic correction.
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Affiliation(s)
- Qingyu Wu
- Heart Center, First Hospital of Tsinghua University, Beijing, China.
| | - Guangyu Pan
- Heart Center, First Hospital of Tsinghua University, Beijing, China
| | - Hongyin Li
- Heart Center, First Hospital of Tsinghua University, Beijing, China
| | - Xiangchen Kong
- Heart Center, First Hospital of Tsinghua University, Beijing, China
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Wei W, Zhan X, Xue Y, Fang X, Liao H, Deng H, Liang Y, Wu S. Features of accessory pathways in adult Ebstein's anomaly. Europace 2014; 16:1619-25. [DOI: 10.1093/europace/euu028] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Negoi RI, Ispas AT, Ghiorghiu I, Filipoiu F, Negoi I, Hostiuc M, Hostiuc S, Ginghina C. Complex Ebstein's Malformation: Defining Preoperative Cardiac Anatomy and Function. J Card Surg 2013; 28:70-81. [DOI: 10.1111/jocs.12032] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ruxandra Irina Negoi
- Universityof Medicine and Pharmacy “Carol Davila”; Bucharest Romania
- “Prof. Dr. C.C. Iliescu” Institute of Cardiovascular Diseases; Bucharest Romania
| | | | - Ioana Ghiorghiu
- “Prof. Dr. C.C. Iliescu” Institute of Cardiovascular Diseases; Bucharest Romania
| | - Florin Filipoiu
- Universityof Medicine and Pharmacy “Carol Davila”; Bucharest Romania
| | - Ionut Negoi
- Universityof Medicine and Pharmacy “Carol Davila”; Bucharest Romania
| | - Mihaela Hostiuc
- Universityof Medicine and Pharmacy “Carol Davila”; Bucharest Romania
| | - Sorin Hostiuc
- Universityof Medicine and Pharmacy “Carol Davila”; Bucharest Romania
| | - Carmen Ginghina
- Universityof Medicine and Pharmacy “Carol Davila”; Bucharest Romania
- “Prof. Dr. C.C. Iliescu” Institute of Cardiovascular Diseases; Bucharest Romania
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Krieger EV, Valente AM. Diagnosis and Management of Ebstein Anomaly of the Tricuspid Valve. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:594-607. [DOI: 10.1007/s11936-012-0209-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Attenhofer Jost CH, Connolly HM, Scott CG, Burkhart HM, Warnes CA, Dearani JA. Outcome of cardiac surgery in patients 50 years of age or older with Ebstein anomaly: survival and functional improvement. J Am Coll Cardiol 2012; 59:2101-6. [PMID: 22651867 DOI: 10.1016/j.jacc.2012.03.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 02/23/2012] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study sought to analyze the presentation, surgical procedures, and outcomes in patients ≥ 50 years of age with Ebstein anomaly (EA). BACKGROUND Data on management and surgical outcomes in older patients with EA are limited. METHODS Operative and clinical data from patients with EA ≥ 50 years of age undergoing cardiac surgery at our center between October 1980 and January 2010 were analyzed. RESULTS During the study period, 89 procedures were performed in 81 patients with EA (63% women; mean [range] age 59 [50 to 79] years). Pre-operative symptoms included palpitations (n = 69), edema (n = 30), and previous stroke/transient ischemic attack (n = 21). Seventy-six patients (85%) had functional class III or IV symptoms, and 13 (16%) had previous cardiac surgery. Tricuspid valve surgery was necessary in 87 of the 89 procedures (98%): replacement in 65 (73%) and repair in 22 (25%). Three early deaths occurred (4%). On long-term follow-up (available in 73 of 78 early survivors), 63 patients (89%) had improved functional class and 13 patients died (19%). The 20-year survival was 65% versus 74% for age- and sex-matched controls (p = 0.001). The best predictors of late death were lack of post-operative improvement and older age at surgery. CONCLUSIONS Although cardiac surgery in patients with EA ≥ 50 years of age was often complex, early mortality was low (4%) when surgery was performed at an experienced center. Long-term survival was good, although less than expected. These data suggested that surgery in older patients with EA may have to be performed earlier.
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Recomendações da ESC para o tratamento da cardiopatia congénita no adulto (nova versão de 2010). Rev Port Cardiol 2012. [DOI: 10.1016/j.repc.2012.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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31
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Lincoln T, Stewart C, Shah P. An Unusual First Presentation of Ebstein's Anomaly in a 72-Year-Old Patient. Ann Thorac Surg 2012; 93:e19-20. [DOI: 10.1016/j.athoracsur.2011.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 08/06/2011] [Accepted: 08/09/2011] [Indexed: 10/14/2022]
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Baumgartner H, Bonhoeffer P, De Groot NMS, de Haan F, Deanfield JE, Galie N, Gatzoulis MA, Gohlke-Baerwolf C, Kaemmerer H, Kilner P, Meijboom F, Mulder BJM, Oechslin E, Oliver JM, Serraf A, Szatmari A, Thaulow E, Vouhe PR, Walma E, Bax J, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, McDonagh T, Swan L, Andreotti F, Beghetti M, Borggrefe M, Bozio A, Brecker S, Budts W, Hess J, Hirsch R, Jondeau G, Kokkonen J, Kozelj M, Kucukoglu S, Laan M, Lionis C, Metreveli I, Moons P, Pieper PG, Pilossoff V, Popelova J, Price S, Roos-Hesselink J, Uva MS, Tornos P, Trindade PT, Ukkonen H, Walker H, Webb GD, Westby J. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 2010; 31:2915-57. [PMID: 20801927 DOI: 10.1093/eurheartj/ehq249] [Citation(s) in RCA: 1521] [Impact Index Per Article: 108.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Helmut Baumgartner
- Adult Congenital and Valvular Heart Disease Center (EMAH-Zentrum) Muenster, Department of Cardiology and Angiology, University Hospital Muenster, Albert-Schweitzer-Str. 33, D-48149 Muenster, Germany.
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Adachi I, Ho SY, Uemura H. Reply to the Editor. J Thorac Cardiovasc Surg 2009. [DOI: 10.1016/j.jtcvs.2009.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Outcomes of surgical management of Ebstein's anomaly of the tricuspid valve. COR ET VASA 2009. [DOI: 10.33678/cor.2009.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Al-Najashi KS, Balint OH, Oechslin E, Williams WG, Silversides CK. Mid-Term Outcomes in Adults With Ebstein Anomaly and Cavopulmonary Shunts. Ann Thorac Surg 2009; 88:131-6. [DOI: 10.1016/j.athoracsur.2009.03.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 03/16/2009] [Accepted: 03/17/2009] [Indexed: 10/20/2022]
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Adachi I, Ho SY, McCarthy KP, Uemura H. Coronary blood supply of the inferior wall of the right ventricle in hearts with Ebstein malformation: relevance to vertical plication. J Thorac Cardiovasc Surg 2009; 136:1437-41. [PMID: 19114186 DOI: 10.1016/j.jtcvs.2008.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 04/16/2008] [Accepted: 06/15/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Vertical plication of the atrialized chamber in Ebstein malformation has been subject to debate. A major argument against it is risk of coronary arterial injury; however, the coronary anatomy in the malformation remains incompletely investigated. METHODS We examined 17 autopsied hearts with the malformation. Special attention was paid to the coronary blood supply of the right ventricular inferior wall, focusing on the course of the posterior descending branch and its relationship with the interventricular septum. RESULTS The right coronary artery was dominant in 11 cases (65%); the remaining 6 had left dominance. In 6 right-dominant hearts, the right coronary artery gave rise to the branch before reaching the crux of the heart. This early takeoff caused the entire branch to be deviated rightward. Another 2 right-dominant hearts showed rightward deviation of the branch course after an initial short segment along the septum. In contrast, in 2 left-dominant hearts, the left circumflex artery ran beyond the crux and then gave rise to the branch, again resulting in rightward deviation of the branch. These deviations allowed the branch to run on the thin walled part of the right ventricular inferior wall where endocardial stitches are placed during typical vertical plication. CONCLUSION The posterior descending branch was frequently (10/17, 59%) deviated toward the right side relative to the interventricular septum in hearts with Ebstein malformation. Because of this and the thinness of the atrialized ventricular wall, care should be taken to the branch even with superficial endothelial stitches.
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Affiliation(s)
- Iki Adachi
- Cardiac Morphology Unit, Imperial College London, National Heart & Lung Institute, London, UK
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Van Arsdell G. Can we modify late functional outcome in Ebstein anomaly by altering surgical strategy? J Am Coll Cardiol 2008; 52:467-9. [PMID: 18672168 DOI: 10.1016/j.jacc.2008.04.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Accepted: 04/29/2008] [Indexed: 11/28/2022]
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Palmen M, de Jong PL, Klieverik LM, Venema AC, Meijboom FJ, Bogers AJ. Long-term follow-up after repair of Ebstein's anomaly. Eur J Cardiothorac Surg 2008; 34:48-54. [DOI: 10.1016/j.ejcts.2008.03.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 02/27/2008] [Accepted: 03/21/2008] [Indexed: 11/30/2022] Open
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Häussler A, Prêtre R. Surgical correction of Ebstein anomaly: the Zurich approach. Multimed Man Cardiothorac Surg 2008; 2008:mmcts.2006.002428. [PMID: 24415366 DOI: 10.1510/mmcts.2006.002428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ebstein's anomaly is a congenital defect primarily due to a failed-development of the tricuspid valve. The defect affects significantly surrounding structures (conducting tissue, right atrium and ventricle), which often need concomitant correction. We have extended our techniques for the repair of conventional atrio-ventricular valve insufficiency to this specific pathology. The video sequences show the repair of a severe form of Ebstein's anomaly with extensive mobilisation of the displaced leaflets and creation of a subvalvular apparatus with artificial chordae. Because of the absence of arrhythmia, the adjunction of ablation surgery to abnormal atrio-ventricular pathways was not necessary in this case and is not demonstrated in the videos.
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Affiliation(s)
- Achim Häussler
- Division of Pediatric Cardiovascular Surgery, University and Children Hospital Zürich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
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Wu Q, Huang Z, Pan G, Wang L, Li L, Xue H. Early and midterm results in anatomic repair of Ebstein anomaly. J Thorac Cardiovasc Surg 2007; 134:1438-40; discussion 1440-2. [PMID: 18023660 DOI: 10.1016/j.jtcvs.2007.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Revised: 08/22/2007] [Accepted: 08/30/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We report the results of surgical treatment of Ebstein anomaly during a 10-year period, especially with an anatomic repair technique that restores to near normal anatomic and physiologic function of the tricuspid valve and the right ventricle. METHODS Between December 1997 and December 2006, 83 consecutive patients aged 9 months to 52 years underwent operation for Ebstein anomaly. Among them, 78 underwent the anatomic repair technique (male 39). Tricuspid incompetence was moderate in 22 patients and severe in 56 patients. The main surgical technique includes excision of the atrialized right ventricle, detachment and repair of the leaflet, transposition of the leaflet, and anulus plication of the tricuspid valve. In some patients in whom the septal leaflet was severely hypoplastic or absent, a new leaflet was created with autologous pericardium. Biventricular repair was not performed in 5 patients with very severely hypoplastic tricuspid valves and poor right ventricular function. RESULTS All patients survived and recovered uneventfully. For the 78 patients who underwent anatomic repair, postoperative echocardiography showed that tricuspid incompetence disappeared in 65 patients and was mild in 13 patients. Right ventricular function was good. Patients have been doing well during a mean follow-up of 46 months (2 months to 9 years). The latest follow-up echocardiograms showed that tricuspid incompetence was eliminated in 55 patients and was mild in 17, moderate in 3, and severe in 3. The 5 patients with a total cavopulmonary connection procedure and one-and-one-half-ventricle correction procedure are also doing well. CONCLUSIONS Satisfactory early and midterm results can be achieved with the anatomic repair technique to correct Ebstein anomaly. Tricuspid valve replacement can be avoided in most patients.
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Affiliation(s)
- Qingyu Wu
- Heart Center, First Hospital of Tsinghua University, Beijing, China
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Komoda T, Komoda S, Nagdyman N, Berger F, Hetzer R. Combination of a Hetzer operation and a Sebening stitch for Ebstein's anomaly. Gen Thorac Cardiovasc Surg 2007; 55:355-9. [DOI: 10.1007/s11748-007-0146-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Drago F, Brancaccio G, Grutter G, De Santis A, Fazio G, Silvetti MS. Successful radiofrequency ablation of atrial tachycardias in surgically repaired Ebstein's anomaly using the Carto XP system and the QwikStar catheter. J Cardiovasc Med (Hagerstown) 2007; 8:459-62. [PMID: 17502764 DOI: 10.2459/01.jcm.0000269711.11059.3b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe the case of a child with three different atrial tachyarrhythmias originating from the right atrium, in whom a limited modified maze procedure was performed during surgical repair of an Ebstein's anomaly. Successful radiofrequency transcatheter ablation of all atrial tachyarrhythmias, one re-entrant and two focal, was obtained using the Carto XP EP three-dimensional navigation and ablation system, the new QwikMap software technology and the new mapping/ablation QwikStar multipolar catheter. No conventional mapping was used in addition to the three-dimensional system. Total procedural time was about 3 h and fluoroscopy time was 40 min. There were neither recurrences of the tachycardias nor complications during the follow-up (15 months).
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Affiliation(s)
- Fabrizio Drago
- Paediatric Cardiology Department, Bambino Gesù Hospital, Rome, Italy.
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45
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Totsugawa T, Kuinose M, Tsushima Y, Yoshitaka H, Ishida A, Minami H. Sliding tricuspid valvuloplasty for severe tricuspid regurgitation after corrective surgery of a ventricular septal defect. Gen Thorac Cardiovasc Surg 2007; 55:222-4. [PMID: 17554999 DOI: 10.1007/s11748-007-0103-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We encountered a case of massive tricuspid regurgitation after corrective surgery for a ventricular septal defect. Fixation of the septal leaflet to the ventricular septum at the point where it was closed with a pericardial patch and marked annular dilatation were the lesions contributing to the severe tricuspid regurgitation. The posterior leaflet of the tricuspid valve was excised from the tricuspid annulus, slid to the adhering septal leaflet, and then reattached to a safe area of the septal leaflet to prevent conduction disturbance. The sliding repair was supported by annuloplasty with a Carpentier-Edwards ring, and a concomitant right-sided Maze procedure was conducted for atrial flutter.
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Affiliation(s)
- Toshinori Totsugawa
- Department of Cardiovascular Surgery, Cardiovascular Institute Sakakibara Hospital, 2-1-10 Marunouchi, Okayama 700-0823, Japan.
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46
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da Silva JP, Baumgratz JF, da Fonseca L, Franchi SM, Lopes LM, Tavares GMP, Soares AM, Moreira LF, Barbero-Marcial M. The cone reconstruction of the tricuspid valve in Ebstein’s anomaly. The operation: early and midterm results. J Thorac Cardiovasc Surg 2007; 133:215-23. [PMID: 17198815 DOI: 10.1016/j.jtcvs.2006.09.018] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 08/06/2006] [Accepted: 09/06/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We sought to describe a new technique for tricuspid valve repair in Ebstein's anomaly and to report early echocardiographic results, as well as early and midterm clinical outcomes. METHODS From November 1993 through August 2005, 40 consecutive patients with Ebstein's anomaly (mean age, 16.8 +/- 12.3 years) underwent a new surgical repair modified from Carpentier's procedure, the principal details of which are as follows. The anterior and posterior tricuspid valve leaflets are mobilized from their anomalous attachments in the right ventricle, and the free edge of this complex is rotated clockwise to be sutured to the septal border of the anterior leaflet, thus creating a cone the vertex of which remains fixed at the right ventricular apex and the base of which is sutured to the true tricuspid valve annulus level. Additionally, the septal leaflet is incorporated into the cone wall whenever possible, and the atrial septal defect is closed in a valved fashion. RESULTS There was 1 (2.5%) hospital death and 1 late death. Early postoperative echocardiograms have shown good right ventricular morphology and reduction in tricuspid regurgitation grade from 3.6 +/- 0.5 to 1.2 +/- 0.5 (P < .0001). After mean follow-up of 4 years, the functional class (New York Heart Association) improved from 2.6 +/- 0.7 to 1.2 +/- 0.4 (P < .0001). Two patients required late tricuspid valve re-repair, and there was neither atrioventricular block nor tricuspid valve replacement at any time. CONCLUSIONS This surgical technique for Ebstein's anomaly can be performed with low mortality and morbidity. Early echocardiograms showed significant reduction of tricuspid insufficiency, and the follow-up showed improvement in patients' clinical status and low incidence of reoperation.
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Acar P, Abadir S, Roux D, Taktak A, Dulac Y, Glock Y, Fournial G. Ebstein’s Anomaly Assessed by Real-Time 3-D Echocardiography. Ann Thorac Surg 2006; 82:731-3. [PMID: 16863801 DOI: 10.1016/j.athoracsur.2005.09.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Revised: 08/29/2005] [Accepted: 09/06/2005] [Indexed: 11/24/2022]
Abstract
The outcome of patients with Ebstein's malformation depends mainly on the severity of the tricuspid valve malformation. Accurate description of the tricuspid anatomy by two-dimensional echocardiography remains difficult. We applied real-time three-dimensional echocardiography to 3 patients with Ebstein's anomaly. Preoperative and postoperative descriptions of the tricuspid valve were obtained from views taken inside the right ventricle. Surface of the leaflets as well as the commissures were obtained by three-dimensional echocardiography. Real time three-dimensional echocardiography is a promising tool, providing new views that will help to evaluate the ability and efficiency of surgical valve repair in patient with Ebstein's malformation.
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Affiliation(s)
- Philippe Acar
- Medical and Surgical Unit of Pediatric Cardiology, Toulouse, France.
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Sarris GE, Giannopoulos NM, Tsoutsinos AJ, Chatzis AK, Kirvassilis G, Brawn WJ, Comas JV, Corno AF, Di Carlo D, Fragata J, Hraska V, Jacobs JP, Krupianko S, Sairanen H, Stellin G, Urban A, Ziemer G. Results of surgery for Ebstein anomaly: A multicenter study from the European Congenital Heart Surgeons Association. J Thorac Cardiovasc Surg 2006; 132:50-7. [PMID: 16798302 DOI: 10.1016/j.jtcvs.2005.10.062] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2005] [Revised: 09/04/2005] [Accepted: 10/10/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Since most centers' experience with Ebstein anomaly is limited, we sought to analyze the collective experience of participating institutions of the European Congenital Heart Surgeons Association with surgery for this rare malformation. METHODS The records of all 150 patients (median age 6.4 years) who underwent surgery for Ebstein anomaly in the 13 participating Association centers between January 1992 and January 2005 were reviewed retrospectively. Patients with congenitally corrected transposition were excluded. RESULTS Most patients (81%) had Ebstein disease type B or C and significant functional impairment (61% in New York Heart Association class III or IV) and 16% had prior operations. Surgical procedures (n = 179) included valve replacement (n = 60, 33.5%), valve repair (n = 49, 27.3%), 1(1/2) ventricle repair (n = 46, 25.6%), palliative shunt (n = 13, 7.26%), and other complex procedures (n = 11, 6.14%). There were 20 hospital deaths (operative mortality 13.3%) after valve replacement in 5 patients, valve repair in 3, 1(1/2) ventricle repair in 7, palliative procedures in 3, and miscellaneous procedures in 2. Younger age and palliative procedures were univariate risk factors for operative death, but only age was an independent predictor on multivariable analysis. CONCLUSIONS Most patients coming to surgery presented in childhood and were significantly symptomatic. More than half underwent valve replacement or repair, but a considerable proportion had severe disease necessitating 1(1/2) ventricle repair or palliative procedures. Operative mortality did not differ significantly among repair, replacement, and 1(1/2) ventricle repair but was associated with palliative procedures for severe disease early in life, young age being the only independent predictor of operative death.
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Chauvaud SM, Hernigou AC, Mousseaux ER, Sidi D, Hébert JL. Ventricular Volumes in Ebstein’s Anomaly: X-Ray Multislice Computed Tomography Before and After Repair. Ann Thorac Surg 2006; 81:1443-9. [PMID: 16564290 DOI: 10.1016/j.athoracsur.2005.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2005] [Revised: 10/04/2005] [Accepted: 10/04/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study was performed to measure right and left ventricular volumes in Ebstein's anomaly before and after operation. METHODS Twenty-six consecutive patients were operated on with tricuspid valve repair and plication of the atrialized right ventricle, associated with a bidirectional cavopulmonary shunt in 15 patients. Right ventricular (RV) and left ventricular end-diastolic and end-systolic volume indexes were measured by x-ray computerized tomography before and after surgical repair. Left ventricular stroke index and ejection fraction were calculated. RESULTS Before surgery, the mean stroke index of the atrialized RV was 36 +/- 33 mL/m2, with severe reduction in 9 patients and aneurysmal aspect in 2 patients. After surgery, the atrialized RV was no longer identifiable. Both RV end-diastolic volume index and stroke index of the remaining effective RV were reduced. Bidirectional cavopulmonary shunt was a determinant factor of decrease in the effective RV end-diastolic volume index after repair. Conversely, left ventricular ejection fraction and stroke index increased significantly after surgery. CONCLUSIONS The atrialized RV with dyskinesia seems a good indication for a plication. RV end-diastolic volume index of the effective RV decreased after surgery. In severe cases, bidirectional cavopulmonary shunt was useful by decreasing RV end-diastolic volume, thus preventing further RV dilation. In all cases left ventricular ejection fraction and stroke volume index increased after surgery.
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Affiliation(s)
- Sylvain M Chauvaud
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital, Paris, France.
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