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| The Cone Reconstruction of the Tricuspid Valve in Ebstein Anomaly with or without 1.5-Ventricle Repair |
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Jinfen Liu, Lisheng Qiu, Zhongqun Zhu, Huiwen Chen, Haifa Hong; Shanghai Children's Medical Center, Shanghai, China Objective: The cone reconstruction of the tricuspid valve is more and more utilized in the surgical treatment for Ebstein anomaly. The bidirectional cavopulmonary shunt (BCPS), or “one and one-half (1.5) ventricle repair” has been used for the operation of severe anatomic and functional Ebstein anomaly. We sought to review our institutional experience and midterm results of the tricuspid valve cone reconstruction in Ebstein anomaly with or without 1.5-ventricle repair. Methods: From Jan 2004 to Oct 2009, 30 consecutive patients with Ebstein anamoly underwent the tricuspid valve cone reconstruction. All patients had the cone reconstruction of the tricuspid valve and twenty patients with severe Ebstein anomaly had a BCPS constructed. The median age at operation was 60 months (2 months-192 months). Our criteria to use BCPS as an adjunctive surgical way for severe Ebstein anamoly includes: a severely enlarged right-sided chambers, significant abnormality of the septal leaflet of tricuspid valve from morphology and hemodynamic instability after separation from cardiopulmonary bypass. Clinical or echocardiographic characteristics were studied both preoperatively and postoperatively. Results: There was 1(3.3%) hospital death. Before operation, tricuspid incompetence was moderate in 8 and severe in 22. Postoperative early echocardiography showed that tricuspid incompetence was mild in 26, moderate in 3 and severe in 1. After median follow-up time of 22 months, tricuspid incompetence of twenty patients with BCPS was mild in 16 and moderate in 4. Tricuspid incompetence of ten patients without BCPS from the latest echocardiogram(median follow-up time is 32 months) was mild in 4, moderate in 4 and severe in 2. For patients whose postoperative tricuspid imcompetence was beyond mild among ten patients without BCPS, preoperative echocardiogram showed severely dilated right ventricle. 20 patients with BCPS reported no functional limitations at the time of their last follow-up. 4 patients with BCPS reported facial swelling, but this was not problematic. Conclusion: Satisfactory early results can be achieved with the cone reconstruction of the tricuspid valve in the surgical management for Ebstein anomaly. However, for patients with severe Ebstein anamoly, the cone reconstruction of tricuspid valve alone may not be enough to produce ideal midterm results. 1.5-ventricle repair should be added as a planned procedure to the cone reconstruction of the tricuspid valve for patients with severe Ebstein anomaly. Back to 2010 Annual Meeting Back to Program Outline Back to Main Program |
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