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Early and midterm results in anatomic repair of Ebstein anomaly
Qingyu Wu1, Zhixiong Huang, Guangyu Pan
1Heart Center, First Hospital of Tsinghua University, Beijing, China.
Insights
This study shows that an anatomic repair technique for Ebstein anomaly effectively restores tricuspid valve function and right ventricular health, avoiding valve replacement in most patients. Long-term follow-up confirms sustained positive outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pediatric Cardiology
Background:
- Ebstein anomaly is a congenital heart defect characterized by displacement of the tricuspid valve.
- Severe tricuspid regurgitation and right ventricular dysfunction are common in Ebstein anomaly, often requiring surgical intervention.
Purpose of the Study:
- To evaluate the surgical outcomes of an anatomic repair technique for Ebstein anomaly over a 10-year period.
- To assess the technique's ability to restore normal function to the tricuspid valve and right ventricle.
Main Methods:
- A cohort of 83 patients with Ebstein anomaly underwent surgical treatment between 1997 and 2006.
- Seventy-eight patients received an anatomic repair technique involving leaflet repair, transposition, and anulus plication.
- Autologous pericardium was used to reconstruct leaflets in select cases.
Main Results:
- All patients survived the surgery with uneventful recovery.
- Postoperative echocardiography revealed resolution of tricuspid incompetence in 65 patients and mild incompetence in 13.
- Mean follow-up of 46 months showed sustained improvement in tricuspid valve function and good right ventricular function.
Conclusions:
- The anatomic repair technique provides satisfactory early and midterm results for Ebstein anomaly.
- This surgical approach effectively avoids the need for tricuspid valve replacement in the majority of patients.
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.
