Pathological Anatomy and Surgical Correction of Ebstein's Anomaly

Two-dimensional echocardiographic--surgical correlation in Ebstein's anomaly: preoperative determination of patients requiring tricuspid valve plication vs replacement

Two-dimensional echocardiographic features were correlated with surgical findings in 25 patients with Ebstein's anomaly (age 7 days to 71 years). There was excellent agreement between echocardiographic and surgical findings. Echocardiographic observations of anterior leaflet tethering and restriction of motion, as well as small functional right ventricle, were the strongest noninvasively obtained indicators for valve replacement surgery. Plication/annuloplasty (plastic repair) was performed in 17 patients. This group differed from the group needing valve-excision surgery in that the anterior leaflet was elongated, was not tethered, and showed large excursion. These observations support the use of two-dimensional echocardiography as an excellent means for preoperative anatomic assessment of Ebstein's anomaly. This method allowed us to determine which patients were amenable to tricuspid valve excision or plastic repair. A noninvasively derived index of anatomic severity is proposed for easier recognition of patient subgroups.