Postoperative persistent diastolic dyssynchronous expansion in patients with Ebstein's anomaly

Area of Science:

• Cardiology
• Medical Imaging
• Physiology

Background:

• Ebstein's anomaly is characterized by diastolic dyssynchronous expansion (DSE) between the atrialized and functional right ventricles (RV).
• Understanding DSE and its predictors is crucial for surgical outcomes in Ebstein's anomaly.

Purpose of the Study:

• To quantitatively assess DSE in Ebstein's anomaly.
• To identify preoperative factors correlated with persistent DSE after surgical intervention.

Main Methods:

• Retrospective analysis of transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) images in 17 patients with Ebstein's anomaly.
• Quantitative DSE assessment using a DSE index, calculated as the time difference of maximal expansion between RV components divided by cardiac cycle length.
• Correlation analysis with clinical, electrophysiologic parameters, and the tricuspid valve (TV) tethering index.

Main Results:

• A significant correlation was found between the DSE index and the tethering index (rs = 0.664, P = 0.004) in all patients.
• This association persisted postoperatively and at 2-year follow-up in 10 surgically treated patients.
• A tethering index ≥ 2.5 was identified as a predictor for persistent DSE after surgery.

Conclusions:

• Diastolic dyssynchronous expansion is a quantifiable feature of Ebstein's anomaly.
• The severity of tricuspid valve tethering is directly related to DSE and predicts its persistence after surgery.
• Considering the TV tethering index is important for surgical planning to optimize RV functional recovery.