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Li JP, Xie XJ, Yu FX. Giant right atrium due to dysplastic tricuspid valve in an infant: A case report. Asian J Surg 2023:S1015-9584(23)00180-X. [PMID: 36805728 DOI: 10.1016/j.asjsur.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/03/2023] [Indexed: 02/18/2023] Open
Affiliation(s)
- Jin-Ping Li
- Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, 8 Kangcheng Road, Jiangyang District, Luzhou, 646000, PR China
| | - Xiao-Jun Xie
- Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, 8 Kangcheng Road, Jiangyang District, Luzhou, 646000, PR China; Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, PR China
| | - Feng-Xu Yu
- Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, 8 Kangcheng Road, Jiangyang District, Luzhou, 646000, PR China; Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, PR China.
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Gurrieri C, Sharpe EE, Connolly HM, Rose CH, Arendt KW. Peripartum anesthetic management in patients with Ebstein anomaly: a case series. Proc AMIA Symp 2023; 36:346-350. [PMID: 37091760 PMCID: PMC10120540 DOI: 10.1080/08998280.2023.2169561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Ebstein anomaly is a rare congenital cardiac condition associated with displacement and incompetence of the tricuspid valve. Peripartum anesthetic management can be particularly challenging since these patients are at high risk of cardiac failure and tachyarrhythmias. Risk stratification is important since it helps to identify high-risk patients who should deliver at a tertiary care center where a multidisciplinary team (obstetrics, cardiology, anesthesiology, and neonatology) is immediately available. We describe the peripartum anesthetic management of 9 patients with Ebstein anomaly who underwent 12 deliveries at our institution. All patients tolerated neuraxial anesthesia and analgesia well. No maternal or fetal deaths occurred.
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Affiliation(s)
- Carmelina Gurrieri
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Emily E. Sharpe
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Heidi M. Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carl H. Rose
- Division of Maternal and Fetal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Katherine W. Arendt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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3
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Van Praagh R. Tricuspid Valve Anomalies. CONGENIT HEART DIS 2022. [DOI: 10.1016/b978-1-56053-368-9.00013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stephens EH, Dearani JA, Qureshi MY, Ammash N, Maleszewski JJ. The Congenital Tricuspid Valve Spectrum: From Ebstein to Dysplasia. World J Pediatr Congenit Heart Surg 2021; 11:783-791. [PMID: 33164686 DOI: 10.1177/2150135120949235] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ebstein anomaly has a breadth of presentations, including "typical" and "atypical," and can be confused with congenital tricuspid dysplasia. We summarize how to differentiate within this spectrum of disease. Both typical and atypical Ebstein have an underlying failure of delamination, but atypical Ebstein does not have ≥8mm/m2 apical septal leaflet displacement. In congenital tricuspid dysplasia, delamination is normal, while the leaflets and subvalvar apparatus are abnormal. To summarize, the sine qua non feature of Ebstein anomaly, present in both typical and atypical, is the failure of delamination. These are distinct from congenital tricuspid valve dysplasia in which the pathology is in the leaflet itself.
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Affiliation(s)
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, 4352Mayo Clinic, Rochester, MN, USA
| | | | - Naser Ammash
- Department of Cardiovascular Diseases, 4352Mayo Clinic, Rochester, MN, USA
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Abstract
PURPOSE OF REVIEW Ebstein's anomaly (EA) is a rare, but complex form of congenital heart disease consisting of a right ventricular myopathy and morphologic tricuspid valve disease leading to a high incidence of right ventricular dysfunction and arrhythmias. This review offers an updated overview of the current understanding and management of patients with EA with a focus on the adult population. RECENT FINDINGS Increased understanding of anatomic accessory atrioventricular pathways in EA has resulted in an improvement in ablation techniques and long-term freedom of atrial arrhythmia recurrence. Despite an improvement in understanding and recognition of EA, significant disease heterogeneity and complex treatment options continue to challenge providers, with the best outcomes achieved at expert congenital heart disease centers.
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6
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Chambergo-Michilot D, Espinoza-Gutiérrez GA, Gómez JM, Tenorio-Quispe AM. Válvula tricúspide displásica (Ebstein-like). REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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7
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Abstract
Ebstein’s anomaly (EA) is a rare congenital cardiac anomaly. It is a disease at a minimum of the tricuspid valve (TV) and the right ventricular myocardium. Presentation varies from a severe symptomatic form during the neonatal period to an incidental detection later in life due to the wide morphological variation of the condition. The neonatal presentation can be severe and every attempt should be made at medical management ideally into infancy and early childhood. Neonates not eligible or failing medical management should be surgically managed either with a single ventricle palliative approach or a more desirable biventricular repair with a neonatal TV valvuloplasty. Some neonates initially committed to a single ventricle pathway may be converted to a biventricular repair by a delayed TV valvuloplasty. The da Silva Cone repair has become the valvuloplasty of choice especially beyond the neonatal period and can be applied to a wide morphological variation of the condition with good long-term durability. If the chance of a successful TV valvuloplasty is high, it should be offered early in childhood to prevent further cardiac dilation. Adding a Bidirectional Glenn to a valvuloplasty may help salvage marginal risk patients or marginally repairable valves. If valve replacement is the only option, a bioprosthetic valve should be used as it is less thrombogenic especially with marginal right ventricular function. Heart transplantation should be considered in patients with associated left ventricular dysfunction.
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Affiliation(s)
- Sandeep Sainathan
- Department of Surgery, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | | | - Jose Pedro da Silva
- Department of Cardio-thoracic surgery, University of Pittsburgh, Pittsburgh, PA, USA
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8
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The impact of tricuspid valve regurgitation severity on exercise capacity and cardiac-related hospitalisations among adults with non-operated Ebstein's anomaly. Cardiol Young 2019; 29:800-807. [PMID: 31159904 DOI: 10.1017/s1047951119000842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Tricuspid valve regurgitation is an inherent part of Ebstein's anomaly, yet whether the severity of the regurgitation further impairs exercise capacity and contributes to long-term morbidity on top of the lesion severity per se is unknown. METHODS To evaluate for this potential effect, we included 30 patients with Ebstein's anomaly who did not undergo any form of surgical interventions and had a cardiopulmonary exercise test and echocardiographic studies in this retrospective analysis. Echocardiographic studies and cardiopulmonary exercise tests were critically reviewed for lesion severity grade, tricuspid regurgitation degree, and exercise parameters. Cardiac-related hospitalisations were recorded from computerised medical records and during clinic visits. RESULTS Fourteen patients (47%) had moderate and 8 (27%) had severe regurgitation. Patients with ≥ moderate regurgitation exhibited significantly lower exercise capacity (median % predicted maximal oxygen consumption, 62 versus 79%, p = 0.03) and venilatory efficiency at exercise. When stratifying exercise results by regurgitation degree, a stepwise decrease in oxygen consumption and ventilatory efficiency with increasing regurgitation severity was observed, regardless of the anatomic lesion severity. During a median follow-up of 4.6 years, > moderate tricuspid regurgitation was associated with significantly lower cumulative probability of freedom from cardiac hospitalisations. CONCLUSIONS We report that among non-operated Ebstein's anomaly patients, greater tricuspid regurgitation severity was associated with worse exercise capacity and with overall higher probability of cardiac-related hospitalisations independent from the underlying lesion severity.
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9
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A "congenitally corrected" variant of Ebstein's anomaly. Cardiol Young 2018; 28:608-610. [PMID: 29316993 DOI: 10.1017/s1047951117002712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Ebstein's anomaly is a rare CHD that is characterised by caudal displacement of the functional tricuspid annulus and a dysfunctional tricuspid valve owing to a failure of proper leaflet coaptation. We present a balanced variant of Ebstein's anomaly, in which the overgrowth of the septal leaflet had allowed proper coaptation of the tricuspid leaflets, thus preserving the valve function.
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Cabrera R, Miranda-Fernández MC, Huertas-Quiñones VM, Carreño M, Pineda I, Restrepo CM, Silva CT, Quero R, Cano JD, Manrique DC, Camacho C, Tabares S, García A, Sandoval N, Moreno Medina KJ, Dennis Verano RJ. Identification of clinically relevant phenotypes in patients with Ebstein anomaly. Clin Cardiol 2018; 41:343-348. [PMID: 29569399 DOI: 10.1002/clc.22870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/30/2017] [Accepted: 12/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ebstein anomaly (EA) is a heterogeneous congenital heart defect (CHD), frequently accompanied by diverse cardiac and extracardiac comorbidities, resulting in a wide range of clinical outcomes. HYPOTHESIS Phenotypic characterization of EA patients has the potential to identify variables that influence prognosis and subgroups with distinct contributing factors. METHODS A comprehensive cross-sectional phenotypic characterization of 147 EA patients from one of the main referral institutions for CHD in Colombia was carried out. The most prevalent comorbidities and distinct subgroups within the patient cohort were identified through cluster analysis. RESULTS The most prevalent cardiac comorbidities identified were atrial septal defect (61%), Wolff-Parkinson-White syndrome (WPW; 27%), and right ventricular outflow tract obstruction (25%). Cluster analysis showed that patients can be classified into 2 distinct subgroups with defined phenotypes that determine disease severity and survival. Patients in cluster 1 represented a particularly homogeneous subgroup with a milder spectrum of disease, including only patients with WPW and/or supraventricular tachycardia (SVT). Cluster 2 included patients with more diverse cardiovascular comorbidities. CONCLUSIONS This study represents one of the largest phenotypic characterizations of EA patients reported. The data show that EA is a heterogeneous disease, very frequently associated with cardiovascular and noncardiovascular comorbidities. Patients with WPW and SVT represent a homogeneous subgroup that presents with a less severe spectrum of disease and better survival when adequately managed. This should be considered when searching for genetic causes of EA and in the clinical setting.
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Affiliation(s)
- Rodrigo Cabrera
- Laboratorio de Biología Molecular y Pruebas Diagnósticas de Alta Complejidad, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Marta Catalina Miranda-Fernández
- Laboratorio de Biología Molecular y Pruebas Diagnósticas de Alta Complejidad, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Victor Manuel Huertas-Quiñones
- Instituto de Cardiopatías Congénitas, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.,Facultad de Medicina, Universidad del Rosario, Bogotá, Colombia
| | - Marisol Carreño
- Departamento de Cirugía Cardiovascular, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Ivonne Pineda
- Departamento de Cirugía Cardiovascular, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Carlos M Restrepo
- Centro de Investigación en Genética y Genómica-CIGGUR, Grupo GENIUROS, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Claudia Tamar Silva
- Centro de Investigación en Genética y Genómica-CIGGUR, Grupo GENIUROS, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Rossi Quero
- Centro de Investigación en Genética y Genómica-CIGGUR, Grupo GENIUROS, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Juan David Cano
- Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá, Colombia
| | | | - Camila Camacho
- Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Sebastián Tabares
- Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Alberto García
- Instituto de Cardiopatías Congénitas, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,Facultad de Medicina, Universidad del Rosario, Bogotá, Colombia.,Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá, Colombia.,Facultad de Medicina, Universidad El Bosque, Bogotá, Colombia
| | - Néstor Sandoval
- Instituto de Cardiopatías Congénitas, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,Facultad de Medicina, Universidad del Rosario, Bogotá, Colombia
| | | | - Rodolfo José Dennis Verano
- Departamento de Investigaciones, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
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11
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Kumar Vikraman S, Chandra V, Balakrishnan B, Jaiman S, Batra M, Kannoly G. Unguarded tricuspid orifice---a rare cause of fetal right atrial dilatation with characteristic color doppler sign: Case report with review of literature. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:370-374. [PMID: 27753109 DOI: 10.1002/jcu.22416] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 08/25/2016] [Accepted: 09/08/2016] [Indexed: 06/06/2023]
Abstract
The anatomic causes for fetal right atrial dilatation with tricuspid regurgitation include Ebstein anomaly, tricuspid dysplasia, unguarded tricuspid orifice, and Uhl anomaly. Unguarded tricuspid orifice is characterized by complete or partial agenesis of the tricuspid valvular and subvalvular structures. It is commonly associated with pulmonary atresia. Its prenatal diagnosis is usually associated with unfavorable prognosis. We present a prenatally diagnosed case of fetal unguarded tricuspid orifice with description of its diagnostic workup, along with a review of literature, to enhance the understanding of this rarely reported entity. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:370-374, 2017.
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Affiliation(s)
- Seneesh Kumar Vikraman
- Feto-Maternal Medicine, Centre for Infertility and Assisted Reproduction, Edappal Hospitals Private Limited, Edappal, Kerala, India, 679576
| | - Vipin Chandra
- Feto-Maternal Medicine, Centre for Infertility and Assisted Reproduction, Edappal Hospitals Private Limited, Edappal, Kerala, India, 679576
| | - Bijoy Balakrishnan
- Feto-Maternal Medicine, Centre for Infertility and Assisted Reproduction, Edappal Hospitals Private Limited, Edappal, Kerala, India, 679576
| | - Sunil Jaiman
- Surgical Placental Pathology Laboratory, Wayne State University School of Medicine, Detroit, MI
| | - Meenu Batra
- Feto-Maternal Medicine, Centre for Infertility and Assisted Reproduction, Edappal Hospitals Private Limited, Edappal, Kerala, India, 679576
| | - Gopinathan Kannoly
- Feto-Maternal Medicine, Centre for Infertility and Assisted Reproduction, Edappal Hospitals Private Limited, Edappal, Kerala, India, 679576
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13
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Arya P, Beroukhim R. Ebstein Anomaly: Assessment, Management, and Timing of Intervention. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:338. [DOI: 10.1007/s11936-014-0338-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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14
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Shankarappa RK, Papaiah S, Karur S, Math RS, Nanjappa MC. Giant right atrium due to congenital dysplastic tricuspid valve in an elderly female patient. Echocardiography 2013; 30:E128-31. [PMID: 23489067 DOI: 10.1111/echo.12160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Isolated tricuspid valve disease is rare. We report the case of a 65-year-old female patient who presented with right heart failure. Initial echocardiographic evaluation revealed a giant right atrium (RA) with severe tricuspid inflow obstruction with regurgitation. A comprehensive two- and three-dimensional echocardiographic evaluation revealed a dysplastic tricuspid valve resulting in the inflow obstruction and regurgitation. Rheumatic and carcinoid etiologies were ruled out by relevant tests. It is very rare for dysplastic tricuspid valve to present in late adulthood. The classic echocardiographic findings are discussed followed by a brief review of the literature.
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Negoi RI, Ispas AT, Ghiorghiu I, Filipoiu F, Negoi I, Hostiuc M, Hostiuc S, Ginghina C. Complex Ebstein's Malformation: Defining Preoperative Cardiac Anatomy and Function. J Card Surg 2013; 28:70-81. [DOI: 10.1111/jocs.12032] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ruxandra Irina Negoi
- Universityof Medicine and Pharmacy “Carol Davila”; Bucharest Romania
- “Prof. Dr. C.C. Iliescu” Institute of Cardiovascular Diseases; Bucharest Romania
| | | | - Ioana Ghiorghiu
- “Prof. Dr. C.C. Iliescu” Institute of Cardiovascular Diseases; Bucharest Romania
| | - Florin Filipoiu
- Universityof Medicine and Pharmacy “Carol Davila”; Bucharest Romania
| | - Ionut Negoi
- Universityof Medicine and Pharmacy “Carol Davila”; Bucharest Romania
| | - Mihaela Hostiuc
- Universityof Medicine and Pharmacy “Carol Davila”; Bucharest Romania
| | - Sorin Hostiuc
- Universityof Medicine and Pharmacy “Carol Davila”; Bucharest Romania
| | - Carmen Ginghina
- Universityof Medicine and Pharmacy “Carol Davila”; Bucharest Romania
- “Prof. Dr. C.C. Iliescu” Institute of Cardiovascular Diseases; Bucharest Romania
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16
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Krieger EV, Valente AM. Diagnosis and Management of Ebstein Anomaly of the Tricuspid Valve. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:594-607. [DOI: 10.1007/s11936-012-0209-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Beitzke D, Wolf F, Edelhauser G, Lammer J, Loewe C. Right heart dilatation in adult congenital heart disease: imaging appearance on cardiac magnetic resonance. Br J Radiol 2010; 84:188-93. [PMID: 21159804 DOI: 10.1259/bjr/13711325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Imaging morphology and function of the right heart is of paramount importance in patients with adult congenital heart disease, since right ventricular dysfunction is associated with adverse cardiac events. Cardiac MRI has been shown to be a powerful tool for the non-invasive precise assessment of right ventricular and valvular dysfunction. Differential diagnoses of congenital heart disease characterised by, or combined with, right heart dilatation are diverse and necessitate a systematic approach.
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Affiliation(s)
- D Beitzke
- Department of Radiology, Medical University of Vienna, Austria.
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, Del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2009; 52:e143-e263. [PMID: 19038677 DOI: 10.1016/j.jacc.2008.10.001] [Citation(s) in RCA: 974] [Impact Index Per Article: 64.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. Circulation 2008; 118:e714-833. [PMID: 18997169 DOI: 10.1161/circulationaha.108.190690] [Citation(s) in RCA: 624] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Prenatal diagnosis of Ebstein’s anomaly using spatio-temporal image correlation (STIC) and inversion mode. Arch Gynecol Obstet 2008; 278:387-91. [DOI: 10.1007/s00404-008-0597-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 02/04/2008] [Indexed: 11/27/2022]
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Trojnarska O, Szyszka A, Gwizdała A, Siniawski A, Oko-Sarnowska Z, Chmara E, Straburzyńska-Migaj E, Katarzyński S, Cieśliński A. Adults with Ebstein's anomaly—Cardiopulmonary exercise testing and BNP levels. Int J Cardiol 2006; 111:92-7. [PMID: 16242194 DOI: 10.1016/j.ijcard.2005.07.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Revised: 07/13/2005] [Accepted: 07/30/2005] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Ebstein's anomaly is defined as the significant apical displacement of the part of the tricuspid valve causing significant tricuspid regurgitation and reduction of the functional right ventricle. The aim of the study was to evaluate exercise capacity with cardiopulmonary stress testing and to determine plasma BNP levels in adults with Ebstein's anomaly, and to establish their relation with echocardiogaphic grading of the lesion severity. MATERIALS AND METHODS Study group consisted of 21 patients (16 males, aged 40.3+/-11.5 years). The control group: 19 healthy individuals (13 males, aged mean 39.9+/-9.3 years). On echocardiography the grade of the lesion severity was calculated (EGE) and used to define the following four groups: I < 0.5, II: 0.5-0.9, III: 1.0-1.49, IV > 1.5. The forced vital capacity (FVC), first second forced expiratory volume (FEV1), peak oxygen uptake (peak VO2), and VE/VCO2 slope were assessed with cardiopulmonary stress test and plasma BNP levels measured with radioimmunometric assay. RESULTS In the studied group VO2 was lower than in control (21.9+/-5.4 vs. 33.6+/-8.3 mL/kg/min [p = 0.00001]), VE/VCO2 slope was higher in Ebstein's group (40.1+/-8.1, p = 0.00001). BNP levels were higher in the Ebstein group then in controls (35.9+/-25.0 vs. 17.2+/-9.9 pg/mL [p = 0.0002]) and did not differ significantly between EGE groups. PeakVO2 of 24.5+/-3.9 in patients from II EGE group were higher than in patients from EGE groups: III (17.2+/-5.2 p = 0.007) and IV (22.9+/-4.7 p = 0.05). CONCLUSIONS Exercise capacity of adults with Ebstein's anomaly is significantly reduced and plasma BNP levels are higher compared to healthy individuals. Exercise capacity in patients with Ebstein's anomaly becomes gradually lower alongside the EGE severity; however, BNP levels do not correlate significantly with this parameter.
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Affiliation(s)
- Olga Trojnarska
- 1st Department of Cardiology, University of Medical Sciences, Poznan, Poland.
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22
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Abstract
In patients with congenital heart disease the right ventricle (RV) may support the pulmonary (subpulmonary RV) or the systemic circulation (systemic RV). During the last 50 years evidence is accumulating that RV dysfunction develops in many of these patients and leads to considerable morbidity and mortality. Therefore RV function in certain groups of congenital heart disease patients needs close surveillance and timely and appropriate intervention to optimise outcomes. Despite major progress being made, assessing the RV either in the subpulmonary or the systemic circulation remains challenging, often requiring a multi-imaging approach and expertise (echocardiography, magnetic resonance imaging, nuclear and occasionally invasive assessment with angiography). This review discusses the implications of volume and pressure loading of the RV in the context of congenital heart disease and describes the most relevant imaging modalities for monitoring RV function.
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Affiliation(s)
- P A Davlouros
- Adult Congenital Heart Centre & Centre for Pulmonary Hypertension, Royal Brompton & Harefield NHS Trust, National Heart and Lung Institute, Imperial College, London, UK.
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Shima Y, Fukumi D, Ogawa S. Intrauterine hemodynamics of tricuspid valve dysplasia in a growth-restricted infant. Arch Gynecol Obstet 2005; 273:366-9. [PMID: 16273410 DOI: 10.1007/s00404-005-0084-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Accepted: 09/01/2005] [Indexed: 11/29/2022]
Abstract
We present a case of fetal tricuspid valve dysplasia, which was diagnosed at 22 weeks of gestation during a routine obstetrical examination. Serial fetal echocardiographic evaluation revealed progressive right ventricular outflow tract obstruction and persistent cardiomegaly. A female infant weighing 1,916 g was delivered by elective cesarean section at 38 weeks of gestation. Longstanding compression of the fetal lungs secondary to the persistent cardiomegaly resulted in severe respiratory distress and cyanosis immediately after birth. Although, mechanical ventilation and continuous infusion of prostaglandin were instituted, the infant died of respiratory failure at 21 days of age. During the pregnancy, the fetus exhibited intrauterine growth restriction, but hydrops did not occur. In regard to the fetal hemodynamics in this cardiac anomaly, transatrial communication is essential for fetal survival. The diameter of the fossa ovalis, which is a marker of transtrial blood flow, was adequate in this case. However, marked enlargement of the right heart associated with regurgitation interfered with left ventricular filling and output, which resulted in restriction of the combined ventricular output and intrauterine fetal growth restriction.
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Affiliation(s)
- Yoshio Shima
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
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Saxena R, Woytash J, Wright JR. A rare tricuspid anomaly. Arch Pathol Lab Med 2005; 129:1495-6. [PMID: 16253036 DOI: 10.5858/2005-129-1495-arta] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rakhee Saxena
- Department of Pathology, State University of New York, Buffalo, NY, USA.
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Kobza R, Kurz DJ, Oechslin EN, Prêtre R, Zuber M, Vogt P, Jenni R. Aberrant tendinous chords with tethering of the tricuspid leaflets: a congenital anomaly causing severe tricuspid regurgitation. Heart 2004; 90:319-23. [PMID: 14966058 PMCID: PMC1768112 DOI: 10.1136/hrt.2002.006254] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To define the entity of tricuspid regurgitation caused by tethering of the tricuspid valve leaflets by aberrant tendinous chords. DESIGN Retrospective study. SETTING Tertiary care centre (university teaching hospital). PATIENTS 10 patients with unexplained severe tricuspid regurgitation. METHODS The last 13 500 echocardiographic studies from our facility were reviewed to identify patients with severe unexplained tricuspid regurgitation. Tethering was defined by the presence of aberrant tendinous chords to the tricuspid valve leaflets limiting the mobility of the tricuspid leaflet and resulting in incomplete coaptation and apical displacement of the regurgitant jet origin. Aberrant tendinous chords were defined as those inserting at the clear zone of the tricuspid leaflet and not originating from the papillary muscle. Patients fulfilling the diagnostic criteria for Ebstein's anomaly were excluded. RESULTS 10 patients with aberrant tendinous chords tethering one or more tricuspid valve leaflets were identified. There were short non-aberrant tendinous chords in seven patients, five of whom also had right ventricular or tricuspid annulus dilatation. CONCLUSIONS Tethering of the tricuspid valve leaflets by aberrant tendinous chords can be the sole mechanism of congenital tricuspid regurgitation. It is often associated with short non-aberrant tendinous chords, which may develop secondary to right ventricular or tricuspid annulus dilatation. Awareness of tethering as a cause of tricuspid regurgitation may be important in planning reconstructive surgery.
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Affiliation(s)
- R Kobza
- Echocardiography, Cardiovascular Centre, University Hospital Zurich, Zurich, Switzerland
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Flores Arizmendi A, Fernández Pineda L, Quero Jiménez C, Maître Azcárate MJ, Herráiz Sarachaga I, Urroz E, Pérez de León J, Luis Moya J, Quero Jiménez M. The clinical profile of Ebstein's malformation as seen from the fetus to the adult in 52 patients. Cardiol Young 2004; 14:55-63. [PMID: 15237672 DOI: 10.1017/s1047951104001106] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Ebstein's malformation of the tricuspid valve is a rare but complex congenital cardiac lesion characterised by a variable degree of dysplasia and displacement of the proximal attachments of its inferior and septal leaflets from the true atrioventricular junction. The aim of our retrospective study is to report the risk factors for mortality, and to determine the clinical profile as seen in 52 cases diagnosed in our service between 1978 and 2002, concentrating in particular on the outcome for the neonatal patient. There were 26 females and 26 males, and the age at presentation ranged from 30 weeks gestational age to 46 years. We found 23 associated cardiac anomalies in 20 cases. Of the patients, 11 patients (21%) died. Actuarial survival at 30 years was 65%. Predictors of death included fetal or neonatal presentation, presence of associated defects, a grade within the Celermajer index of 3 or 4, and a cardiothoracic ratio equal to or greater than 65%. The diagnosis was made in the neonatal period in 24 patients, nine of whom died. Of the 15 survivors, only 4 are free of symptoms. Surgical treatment was undertaken in 9 patients, with a mortality rate of 33% without late deaths, with all the survivors being in good condition. The mean period of follow-up for the 41 living patients was 16.5 years. An arrhythmia of variable severity appeared during the evolution of 27 patients (66%). At present, only 7 cases are in the functional class III or IV of the grading system of the New York Heart Association, but 25 patients (61%) needed some medical treatment, meanly for arrhythmic events. Thus, fetal and neonatal presentation of Ebstein's malformation is associated with a poor outcome. Moreover, the echocardiographic appearance, marked cardiomegaly, and the presence of associated lesions are all risk factors for mortality. Arrhythmia and need of medical treatment are common in older children and adults. Survival after surgical treatment is associated with a good outcome.
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Vettraino IM, Huang R, Comstock CH. The normal offset of the tricuspid septal leaflet in the fetus. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2002; 21:1099-1104. [PMID: 12369664 DOI: 10.7863/jum.2002.21.10.1099] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To quantify the normal distance between the insertion of the medial leaflets of the mitral valve and tricuspid valve in the fetal heart. This mitral valve-tricuspid valve distance was compared with the distance from known cases of Ebstein anomaly. METHODS An apical 4-chamber view was obtained at end diastole in fetuses between 18 and 41 weeks' gestation. Calipers were placed parallel to the ventricular septum, with 1 caliper on the medial insertion of the mitral valve and a second caliper on the medial insertion of the tricuspid valve. The distance recorded was plotted against gestational age. Statistical analysis was performed by descriptive and linear regression techniques. RESULTS One hundred forty-five fetuses were studied. The mean +/- SD mitral valve-tricuspid valve distance in the second trimester was 2.8 +/- 0.9 mm with a range of 1.2 to 5.0 mm; in the third trimester it was 4.6 +/- 1.1 mm with a range of 2.2 to 6.9 mm. Regression analysis showed that with each 1-week increase in gestational age, there was an increase of 0.15 mm in separation between the medial leaflets of the mitral valve and tricuspid valve (beta = 0.15 +/- 0.011). CONCLUSIONS A positive correlation between mitral valve-tricuspid valve distance and advancing gestational age was found. The reference range described allows for the identification of a fetal heart with normal variation in the mitral valve-tricuspid valve distance. Further downward displacement of the medial tricuspid cusp suggests the possibility of Ebstein anomaly.
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Affiliation(s)
- Ivana M Vettraino
- Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan 48073-6769, USA
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Knott-Craig CJ, Overholt ED, Ward KE, Ringewald JM, Baker SS, Razook JD. Repair of Ebstein's anomaly in the symptomatic neonate: an evolution of technique with 7-year follow-up. Ann Thorac Surg 2002; 73:1786-92; discussion 1792-3. [PMID: 12078770 DOI: 10.1016/s0003-4975(02)03507-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ebstein's anomaly in the severely symptomatic neonate is usually fatal. Until recently, successful repair has not been reported and various palliative operations have been associated with prohibitive mortality. Recently, we published our initial results with biventricular repair in 3 severely symptomatic neonates. We now update our experience with emphasis on the evolution of our surgical technique and the medium-term follow-up of these patients. METHODS Since 1994, 8 severely symptomatic neonates and young infants underwent biventricular repair by one surgeon. Six had Ebstein's anomaly and 2 had physiologically similar pathology with severe tricuspid valve dysplasia, cyanosis, and gross cardiomegaly. One Ebstein patient (2 months old) had undergone a Starnes operation elsewhere. Weight of the patients at operation ranged from 2.1 to 6.4 kg (mean 2.7 kg). Five patients had either anatomical (n = 3) or functional (n = 2) pulmonary atresia. Severe (4/4) tricuspid regurgitation was present in all except 1 (Starnes operation), and cardiothoracic ratio exceeded 0.85 in all patients. Echocardiography severity scores were >1.5 in 6 (grade 4/4) and 1.3 in 1 (grade 3/4). Repair consisted of tricuspid valve repair, reduction atrioplasty, relief of right ventricular outflow tract obstruction, partial closure of atrial septal defect, and correction of all associated cardiac defects. Technique of tricuspid valve repair evolved over time: 3 had Danielson-type repairs, 3 had DeVega-type repairs, and 2 had complex repairs. RESULTS One patient died in hospital: a 2.1 kg patient with tricuspid dysplasia, anatomical pulmonary atresia, and hypoplastic pulmonary arteries. The other 7 patients are all in functional class I and in sinus rhythm. Although 3 patients had symptomatic tachyarrhythmias before surgery, no child has experienced SVT after discharge. At recent echocardiography 4 patients had mild tricuspid regurgitation, and 2 had mild-moderate (2/4) tricuspid regurgitation. Three patients are now 7 years old, 2 are almost 2 years old, and the remaining 2 patients are 1 year old. CONCLUSIONS Surgical repair of the severely symptomatic neonate with Ebstein's anomaly is feasible and safe. The repair appears durable and with good medium-term outcome.
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Affiliation(s)
- Christopher J Knott-Craig
- Section of Thoracic and Cardiovascular Surgery, Children's Hospital at Oklahoma University Medical Center, Oklahoma City 73104, USA.
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Therrien J, Henein MY, Li W, Somerville J, Rigby M. Right ventricular long axis function in adults and children with Ebstein's malformation. Int J Cardiol 2000; 73:243-9. [PMID: 10841966 DOI: 10.1016/s0167-5273(00)00230-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To assess right ventricular function in adults and children with Ebstein's anomaly. DESIGN Prospective study. SETTING Tertiary referral centre. SUBJECTS Fifteen patients (8 adults and 7 children) with Ebstein's anomaly and 14 healthy controls. INTERVENTIONS Transthoracic echocardiography was performed in all. Right ventricular function was assessed from long axis M-mode recordings of the right atrio-ventricular free wall. Total systolic excursion as well as peak shortening and lenghtening rates of the right ventricle were measured. RESULTS Children and adult patients with Ebstein's anomaly differed in terms of age at diagnosis, the adult group having been diagnosed later 19.8+/-15.8 vs. 5.9+/-6.2 years, P<0.05. Measures of right ventricular long axis function in children with Ebstein's anomaly showed a significantly reduced systolic excursion 1.4+/-0.4 vs. 2.4+/-0.53 cm, P<0.05 and peak lenghtening rate; early 8.04+/-4.3 vs. 11.8+/-2.4 cm/s and late 6.14+/-3.6 vs. 10.6+/-4.3 cm/s, P=0.05 compared to controls. In contrast, measurements of right ventricular long axis function in adults with Ebstein's anomaly showed no significant difference when compared to the control group. Transtricuspid Doppler flow velocities were not different between patient's groups and corresponding controls. CONCLUSION The right ventricle assessed by this simple, non-invasive technique reveals a significantly reduced systolic and diastolic function in children with Ebstein's malformation compared to controls but a 'normal' right ventricular function comparable to controls in adult patients. Significant right ventricular dysfunction in children with Ebstein's anomaly could account for their earlier presentation. Long term follow up of the right ventricular abnormalities is needed in such children to discover more about the natural history of the disease.
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Affiliation(s)
- J Therrien
- Cardiac Department, Royal Brompton and Harefield Trust and National Heart and Lung Institute, Imperial College, London, UK
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Knott-Craig CJ, Overholt ED, Ward KE, Razook JD. Neonatal repair of Ebstein's anomaly: indications, surgical technique, and medium-term follow-up. Ann Thorac Surg 2000; 69:1505-10. [PMID: 10881831 DOI: 10.1016/s0003-4975(00)01138-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ebstein's anomaly in the severely symptomatic neonate is usually fatal. Because the mortality for various surgical interventions has been prohibitively high, the indications for operation in these critically ill neonates are unclear. METHODS We reviewed our results with biventricular repair of three consecutive severely symptomatic neonates (2.8 to 3.2 kg) at our institution since 1994. Each had associated complex cardiac pathology, including multiple muscular ventricular septal defects (n = 1), pulmonary stenosis with functional pulmonary atresia (n = 1), and anatomic pulmonary atresia (n = 1). Preoperatively, all infants had severe tricuspid regurgitation, Great Ormond Street Ebstein echocardiogram scores greater than 1.3:1 (grade 3 or 4) and cardiothoracic ratio greater than 0.85. Two patients were severely cyanotic. Hepatic and renal insufficiency with diffuse coagulopathy was present preoperatively in two patients. Surgical repair consisted of (1) reconstruction of a competent monocuspid tricuspid valve, (2) right ventriculorrhaphy, (3) subtotal closure of atrial septal defect (ASD), (4) aggressive reduction atrioplasty, and (5) repair of all associated cardiac defects. RESULTS There were no early or late deaths. All patients are currently asymptomatic, without medications, and in sinus rhythm. At 5-year follow-up, trivial tricuspid regurgitation is present in 1 and mild regurgitation in 2 patients. On the basis of these results and review of the current literature, we propose new indications for surgical repair in the neonate with Ebstein's anomaly. CONCLUSIONS Biventricular repair of Ebstein's anomaly in the critically ill neonate is feasible and medium-term durability of the repair is excellent. Therefore, conventional management of these patients should be revised and early surgical repair encouraged.
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Affiliation(s)
- C J Knott-Craig
- Section of Thoracic and Cardiovascular Surgery, University of Oklahoma Health Sciences Center, Oklahoma City 73190, USA.
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