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J Thorac Cardiovasc Surg 2007;134:1440-1442
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Discussion

Dr Joseph A. Dearani (Rochester, Minn). I congratulate Dr Wu and his team for their excellent results in the surgical treatment of Ebstein anomaly. I have had the good fortune of visiting Dr Wu in China and have observed him perform his repair. He is an innovative and gifted technical surgeon.

All of us are aware of the endless anatomic variability of Ebstein anomaly, and the literature documents a plethora of tricuspid valve repair techniques for this condition. This is the result of limitations and incomplete satisfaction with each of the repair methods available. In my opinion, the best way for the surgeon to optimize his or her ability to repair the Ebstein valve is to be familiar with all of the available techniques and to selectively apply principles and portions of the different techniques to the specific anatomy encountered in the operating room.

Dr Wu’s method is a right ventricular remodeling method that incorporates tricuspid valve repair. I would point out one technical issue for those interested in applying this technique: always think about the right coronary artery when the annulus is plicated at the inferior angle. This can cause an acute angle in the natural circle of the atrioventricular groove and result in right coronary compromise, even though a suture does not actually go around the coronary artery.

Dr Wu, it is apparent from the manuscript and presentation that your patient population differs somewhat from our experience and from others reported in the literature. In your patient cohort, overall anatomic severity was not as complex. One third of your patients had just moderate tricuspid regurgitation. The anterior leaflet was well developed in two thirds of patients. Only one third of patients had an atrial septal defect or patent foramen ovale. Nevertheless, you have applied your technique successfully . . . [Full Text of this Article]

Related Article

Early and midterm results in anatomic repair of Ebstein anomaly

Qingyu Wu, Zhixiong Huang, Guangyu Pan, Lianyi Wang, Lei Li, and Hui Xue
J. Thorac. Cardiovasc. Surg. 2007 134: 1438-1442. [Abstract] [Full Text] [PDF]