Cone Reconstruction for Tricuspid Valve in 19 Patients with Ebstein's Anomaly: A Clinical Analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SUIRun-qian , ZIJie , LIYong , LIDe-cai ,  WANGAn-biao

Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, P. R. China;

Corresponding?author：

WANGAn-biao, Email: 313823871@qq.com

Keywords：

Ebstein anomaly; Tricuspid valve; Surgical strategy; Perioperative period

DOI：

10.7507/1007-4848.20160165

Video：

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Objective We sought to review our experience of cone reconstruction for tricuspid valve repair and to evaluate this therapeutic approach for patients with Ebstein's anomaly, to report early clinical outcomes. Method We retrospectively analyzed the clinical data of 19 consecutive patients underwent cone reconstruction technique in our hospital between December 2011 and June 2014 year. There were 8 males and 11 females at mean age 24 years(ranged from 3 months to 53 years). Six patients were diagnosed by electrocardiography or electrophysiology examination, including 4 patients with B type Wolff-Parkinson-White syndrome and atrial fibrillation, 2 patients with paroxysmal supraventricular tachycardia. Results There was one patient of severe cyanosis hospital death for low cardiac output syndrome depending on cardiopulmonary bypass. The remaining patients were recovered smoothly. Atrial fibrillation associated with frequent ventricular premature, restoration of sinus rhythm with lidocaine and amiodarone occurred in one patient. Early postoperative echocardiograms showed good ventricular morphology and reduction in tricuspid regurgitation (TR) grade. Eleven patients were with mild regurgitation and 7 patients without or with trace amounts of regurgitation. All patients were followed up for 5-30 months. And postoperative cardiac function recovered to gradeⅠin 10 patients and gradeⅡ in 8 patients. None of patients needed re-operation. Conclusions The cone reconstruction technique shows low in-hospital mortality and complication rate, reducing TR, restoring right ventricular function, allowing reverse remodeling of the heart. Early postoperative follow-up shows improvement in patients' clinical outcome and low incidence of re-operation.

Citation： SUIRun-qian, ZIJie, LIYong, LIDe-cai, WANGAn-biao. Cone Reconstruction for Tricuspid Valve in 19 Patients with Ebstein's Anomaly: A Clinical Analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(7): 688-691. doi: 10.7507/1007-4848.20160165 Copy

1.	Dearani JA, Said SM, O'Leary PW, et al. Anatomic repair of Ebstein's malformation:lessons learned with cone reconstruction. Ann Thorac Surg, 2013, 95(1) :220-228.
2.	周永昌, 郭萬學. 主編. 超聲醫學. 第4版. 北京:科學技術出版社, 2002.537-539.
3.	Carpentier A, Chauvaud S, Macé L, et al. A new reconstructive operation for Ebstein's anomaly of the tricuspid valve. J Thorac Cardiovasc Surg, 1988, 96(1) :92-101.
4.	張懷軍, 許建屏, 宋云虎. 成人Ebstein's畸形的臨床特征及外科治療策略. 中國胸心血管外科臨床雜志, 2014, 21(4) :465-467.
5.	譚林. Ebstein畸形的外科治療進展. 中國胸心血管外科臨床雜志, 2010, 17(4) :326-330.
6.	Danielson GK, Driscoll DJ, Mair DD, et al. Operative treatment of Ebstein's anomaly. J Thorac Cardiovasc Surg, 1992, 104(5) :1195-1202.
7.	Hetzer R, Nagdyman N, Ewert P, et al. A modified repair technique for tricuspid incompetence in Ebstein's anomaly. J Thorac Cardiovasc Surg, 1998, 15(4) :857-868.
8.	Brown ML, Dearani JA, Danielson GK, et al. The outcomes of opera-tions for 539 patients with Ebstein anomaly. J Thorac Cardiovasc Surg, 2008, 135(5) :1120-1137.
9.	何維來, 周汝元, 葛圣林, 等. 改良Carpentier 法矯治三尖瓣下移畸形. 中國胸心血管外科臨床雜志, 2012, 19(1) :22-25.
10.	Palmen M, de Jong PL, Klieverik LM, et al. Long-term follow-up after repair of Ebstein's anomaly. Eur J Cardiothorac Surg, 2008, 34(1) :48-54.
11.	Silva JP, Silva Lda F, Moreira LF, et al. Cone reconstruction in Ebstein's anomaly repair:early and long-term results. Arq Bras Cardiol, 2011, 97(3) :199-208.
12.	da Silva JP, da Silva Lda F. Ebstein's anomaly of the tricuspid valve:the cone repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2012, 15(1) :38-45.
13.	da Silva JP, Baumgratz JF, da Fonseca L, et al. The cone reconstru-ction of the tricuspid valve in Ebstein's anomaly. The operation:early and midterm results. J Thorac Cardiovasc Surg, 2008, 133(1) :215-223.
14.	Dearani JA, Said SM, O'Leary PW, et al. Anatomic repair of Ebstein's malformation:lessons learned with cone reconstruction. Ann Thorac Surg, 2013, 95(1) :220-228.
15.	許建屏, 高峰, 吳清玉, 等. 三尖瓣下移畸形的外科治療. 中華胸心血管外科雜志, 2005, 21(6) :368-369.

1. Dearani JA, Said SM, O'Leary PW, et al. Anatomic repair of Ebstein's malformation:lessons learned with cone reconstruction. Ann Thorac Surg, 2013, 95(1) :220-228.
2. 周永昌, 郭萬學. 主編. 超聲醫學. 第4版. 北京:科學技術出版社, 2002.537-539.
3. Carpentier A, Chauvaud S, Macé L, et al. A new reconstructive operation for Ebstein's anomaly of the tricuspid valve. J Thorac Cardiovasc Surg, 1988, 96(1) :92-101.
4. 張懷軍, 許建屏, 宋云虎. 成人Ebstein's畸形的臨床特征及外科治療策略. 中國胸心血管外科臨床雜志, 2014, 21(4) :465-467.
5. 譚林. Ebstein畸形的外科治療進展. 中國胸心血管外科臨床雜志, 2010, 17(4) :326-330.
6. Danielson GK, Driscoll DJ, Mair DD, et al. Operative treatment of Ebstein's anomaly. J Thorac Cardiovasc Surg, 1992, 104(5) :1195-1202.
7. Hetzer R, Nagdyman N, Ewert P, et al. A modified repair technique for tricuspid incompetence in Ebstein's anomaly. J Thorac Cardiovasc Surg, 1998, 15(4) :857-868.
8. Brown ML, Dearani JA, Danielson GK, et al. The outcomes of opera-tions for 539 patients with Ebstein anomaly. J Thorac Cardiovasc Surg, 2008, 135(5) :1120-1137.
9. 何維來, 周汝元, 葛圣林, 等. 改良Carpentier 法矯治三尖瓣下移畸形. 中國胸心血管外科臨床雜志, 2012, 19(1) :22-25.
10. Palmen M, de Jong PL, Klieverik LM, et al. Long-term follow-up after repair of Ebstein's anomaly. Eur J Cardiothorac Surg, 2008, 34(1) :48-54.
11. Silva JP, Silva Lda F, Moreira LF, et al. Cone reconstruction in Ebstein's anomaly repair:early and long-term results. Arq Bras Cardiol, 2011, 97(3) :199-208.
12. da Silva JP, da Silva Lda F. Ebstein's anomaly of the tricuspid valve:the cone repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2012, 15(1) :38-45.
13. da Silva JP, Baumgratz JF, da Fonseca L, et al. The cone reconstru-ction of the tricuspid valve in Ebstein's anomaly. The operation:early and midterm results. J Thorac Cardiovasc Surg, 2008, 133(1) :215-223.
14. Dearani JA, Said SM, O'Leary PW, et al. Anatomic repair of Ebstein's malformation:lessons learned with cone reconstruction. Ann Thorac Surg, 2013, 95(1) :220-228.
15. 許建屏, 高峰, 吳清玉, 等. 三尖瓣下移畸形的外科治療. 中華胸心血管外科雜志, 2005, 21(6) :368-369.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Cone Reconstruction for Tricuspid Valve in 19 Patients with Ebstein's Anomaly: A Clinical Analysis

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