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J Thorac Cardiovasc Surg 2007;134:1410-1412
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Discussion

Dr V. Mohan Reddy. (Stanford, Calif). I would like to thank the association for the privilege of discussing this manuscript. I would also like to thank the authors for providing me with the manuscript early enough and congratulate them for an elegant presentation and study.

Dr Reemtsen and colleagues report on a 15-year single-institution experience of neonatal Ebstein’s anomaly with an overall mortality of 25% but none since 1996. This approach commits all patients to single—ventricle circulation. Probably some of these could have been a 2-ventricle or a 1-ventricle type of repair based on our experience and review of the literature on neonatal Ebstein’s anomaly. It might be that although this approach yields very good survival, a more balanced individualized approach might yield similar results without committing all patients to single-ventricle repairs.

In your manuscript, at least, I would say that 50% of the patients have a GOS ratio of less than 1. Perhaps in these patients a 2-ventricle or a 1-ventricle type of repair could be attempted as a first option.

Also, by means of right atrial reduction and RV plication, with or without, the GOS ratio immediately decreases if you do a postoperative study. But what is more important in your manuscript is the long-term follow-up and continued remodeling of the ventricle and the septum. This is, I think, the strength of your study.

The authors state that these patients were all catheterized but do not present any data on the catheterization. I have 4 or 5 questions for you, and I would appreciate if you could answer each one of them before I move on to the next.

Do you currently adopt this approach in all neonates or consider 2-ventricle repair in some? If so, what criteria do you use?

Dr Reemtsen. Our goal, . . . [Full Text of this Article]

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Fate of the right ventricle after fenestrated right ventricular exclusion for severe neonatal Ebstein anomaly

Brian L. Reemtsen, Anastasios C. Polimenakos, Brian T. Fagan, Winfield J. Wells, and Vaughn A. Starnes
J. Thorac. Cardiovasc. Surg. 2007 134: 1406-1412. [Abstract] [Full Text] [PDF]