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J Thorac Cardiovasc Surg 2006;132:1289-1290
© 2006 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Discussion

Dr Christopher J. Knott-Craig (Oklahoma City, Okla). I rise to congratulate you on the first major presentation on patients with neonatal Ebstein anomaly and on the continued results that you have shared with us. In your presentation you review a 14-year experience with 16 patients, most of whom underwent RV exclusion and have excellent outcomes based on historical norms.

We also have a good experience with neonatal Ebstein patients, having had the opportunity to operate on 22 of these patients over 12 years; we have taken a different approach in that we have attempted a 2-ventricle repair in all of them with a greater than 70% survival.

Clearly, there is room to do an RV exclusion operation and there is room to do a 2-ventricle repair. The dilemma that we face as surgeons is trying to stratify which patients would do better with one operation versus the other. Can you help us make a decision based on your experience? Do you have any insights that you could share with us based on your most recent experience in this regard?

Dr Reemtsen. I think the million-dollar question is, when should this be done? We think of the RV exclusion as more of a tool to deal with Ebstein anomaly than as an answer. If the valve tissue looks good and we think we can approach a repair and there is a tripartite ventricle with an open RVOT, then we absolutely will attempt to repair the malformation. If we are not able to do, by echocardiogram, an adequate repair, we would do an RV exclusion at that point.

I think the more difficult group is the one in which there is failure at delamination, there is really no identifiable leaflet tissue, and there is an obstructed RVOT. I do not think, at . . . [Full Text of this Article]

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Current surgical therapy for Ebstein anomaly in neonates

Brian L. Reemtsen, Brian T. Fagan, Winfield J. Wells, and Vaughn A. Starnes
J. Thorac. Cardiovasc. Surg. 2006 132: 1285-1289. [Abstract] [Full Text] [PDF]