HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Luciana da Fonseca Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by da Silva, J. P. Articles by Barbero-Marcial, M. Search for Related Content PubMed PubMed Citation Articles by da Silva, J. P. Articles by Barbero-Marcial, M. Related Collections Congenital - cyanotic Valve disease Related Article

J Thorac Cardiovasc Surg 2007;133:215-223
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

The cone reconstruction of the tricuspid valve in Ebstein’s anomaly. The operation: early and midterm results

^a Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
^b Cardiovascular Surgery Division, Beneficencia Portuguesa Hospital, São Paulo, Brazil.

Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29-May 3, 2006.

Received for publication April 28, 2006; revisions received August 6, 2006; accepted for publication September 6, 2006.

^_* Address for reprints: Jose Pedro da Silva, MD, Alameda dos Arapanes 631, ap 101, bl 3, Indianápolis, São Paulo, SP 04524-001, Brazil. (Email: dasilvajp{at}uol.com.br).

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.

Related Article

Discussion
J. Thorac. Cardiovasc. Surg. 2007 133: 221-223. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				C. J. Knott-Craig, S. P. Goldberg, J. A. Ballweg, and U. S. Boston Surgical Decision Making in Neonatal Ebstein's Anomaly: An Algorithmic Approach Based on 48 Consecutive Neonates World Journal for Pediatric and Congenital Heart Surgery, January 1, 2012; 3(1): 16 - 20. [Abstract] [Full Text] [PDF]

				N. Viola, J. J. Vettukattil, and M. P. Haw Restoring Anterior Leaflet Continuity: The Spinnaker Repair of Ebstein's Anomaly Ann. Thorac. Surg., August 1, 2011; 92(2): 752 - 754. [Abstract] [Full Text] [PDF]

				J. Liu, L. Qiu, Z. Zhu, H. Chen, and H. Hong Cone reconstruction of the tricuspid valve in Ebstein anomaly with or without one and a half ventricle repair J. Thorac. Cardiovasc. Surg., May 1, 2011; 141(5): 1178 - 1183. [Abstract] [Full Text] [PDF]

				C. Kreutzer, H. Capelli, N. Sandoval, M. Jatene, and G. Kreutzer Development of Pediatric and Congenital Heart Surgery in Latin America: Accomplishments and Remaining Challenges World Journal for Pediatric and Congenital Heart Surgery, April 1, 2011; 2(2): 301 - 307. [Abstract] [Full Text] [PDF]

				V. Bautista-Hernandez, B. S. Hasan, D. M. Harrild, A. Prakash, D. Porras, J. E. Mayer Jr, P. J. del Nido, and F. A. Pigula Late Pulmonary Valve Replacement in Patients With Pulmonary Atresia and Intact Ventricular Septum: A Case-Matched Study Ann. Thorac. Surg., February 1, 2011; 91(2): 555 - 560. [Abstract] [Full Text] [PDF]

				K. Itatani, K. Miyaji, N. Inoue, and K. Ohara Ebstein anomaly associated with double-orifice tricuspid valve J. Thorac. Cardiovasc. Surg., June 1, 2010; 139(6): e131 - e133. [Full Text] [PDF]

				B. M.S. Shrestha, S. Fukushima, M. Vrtik, I. H. Chong, L. Sparks, H. Jalali, and P. G. Pohlner Partial Replacement of Tricuspid Valve Using Cryopreserved Homograft Ann. Thorac. Surg., April 1, 2010; 89(4): 1187 - 1194. [Abstract] [Full Text] [PDF]

				C. C. Badiu, C. Schreiber, J. Horer, D. J. Ruzicka, M. Wottke, J. Cleuziou, M. Krane, and R. Lange Early timing of surgical intervention in patients with Ebstein's anomaly predicts superior long-term outcome Eur J Cardiothorac Surg, January 1, 2010; 37(1): 186 - 192. [Abstract] [Full Text] [PDF]

				S. P. Malhotra, E. Petrossian, V. M. Reddy, M. Qiu, K. Maeda, S. Suleman, M. MacDonald, O. Reinhartz, and F. L. Hanley Selective Right Ventricular Unloading and Novel Technical Concepts in Ebstein's Anomaly Ann. Thorac. Surg., December 1, 2009; 88(6): 1975 - 1981. [Abstract] [Full Text] [PDF]

				I. Adachi, S. Y. Ho, K. P. McCarthy, and H. Uemura Coronary blood supply of the inferior wall of the right ventricle in hearts with Ebstein malformation: relevance to vertical plication. J. Thorac. Cardiovasc. Surg., December 1, 2008; 136(6): 1437 - 1441. [Abstract] [Full Text] [PDF]

				M. Palmen, P. L. de Jong, L. M. A. Klieverik, A. C. Venema, F. J. Meijboom, and A. J. J. C. Bogers Long-term follow-up after repair of Ebstein's anomaly Eur J Cardiothorac Surg, July 1, 2008; 34(1): 48 - 54. [Abstract] [Full Text] [PDF]

				M. L. Brown, J. A. Dearani, G. K. Danielson, F. Cetta, H. M. Connolly, C. A. Warnes, Z. Li, D. O. Hodge, D. J. Driscoll, and Mayo Clinic Congenital Heart Center The outcomes of operations for 539 patients with Ebstein anomaly. J. Thorac. Cardiovasc. Surg., May 1, 2008; 135(5): 1120 - 1136.e7. [Abstract] [Full Text] [PDF]

				S. Paranon and P. Acar Ebstein's anomaly of the tricuspid valve: from fetus to adult Heart, February 1, 2008; 94(2): 237 - 243. [Full Text] [PDF]

				A. Haussler and R. Pretre Surgical correction of Ebstein anomaly: the Zurich approach MMCTS, January 1, 2008; 2008(0220): mmcts.2006.002428 - mmcts.2006.002428. [Abstract] [Full Text] [PDF]

				N. A.G. Stolf Congenital Heart Surgery in a Developing Country: A Few Men for a Great Challenge Circulation, October 23, 2007; 116(17): 1874 - 1875. [Full Text] [PDF]