Cone reconstruction in the paitents with Ebstein's anomaly_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WEN Shusheng , GAO Qiang , LI Xiaohua , ZAHO Junfei , CHEN Jimei , CEN Jianzheng , XU Gang ,  ZHUANG Jian

Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academic of Medical Science, Guangdong Province Key Laboratory of Structural Heart Disease, Guangzhou, 510080, P.R.China;

Corresponding author：

ZHUANG Jian, Email: zhuangjian5413@tom.com

Keywords：

Ebstein's anomaly; Cone reconstruction; valve regurgitation

DOI：

10.7507/1007-4848.201604066

Video：

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Objective To summarize the experience and prognosis of Cone reconstruction used in Ebstein's anomaly. Methods We retrospectively analyzed the clinical data of 10 consecutive patients with Ebstein's anomaly, who underwent Cone reconstruction in our hospital from January 1, 2012 through February 1, 2015. According to Carpentier's classification, there were 2 patients of type A, 4 of type B, 2 of type B-C and 2 of type C. Results There was no death. One patient had arrhythmia after operation. The mean regurgitation area was 1.4±1.8 cm² after operation, 6.4±6.9 cm² at the time of discharge, respectively. Both of them were lower than preoperative regurgitation area (18.7±11.4 cm²) with statistical differences (95%CI –25.154 to –9.573,P=0.001; 95%CI 6.567 to 18.113,P=0.001). Three months after operation, the regurgitation was improved significantly compared to the preoperative regurgitation (95%CI 4.523 to 12.052,P=0.004). While it was higher in the regurgitation area when the patients were discharged. However, there was no statistical difference (95%CI –5.783 to 1.039,P=0.126). The incidence of severe regurgitation was about 85.7% at end of 3 months after operation, while decreased to 32.1%, 13 months later. The size of right atrium was much smaller than preoperative size (95%CI 1.033 to 31.480,P=0.039) when the patients were discharged. Conclusion Cone technique with ringed annuoplasty permits a good leaflet-to-leaflet coaptation. Tricuspid competence after operation could be sustained for a long time. However, postoperative short term is the crisis period to severe regurgitation. Further investigation for more appropriate surgical strategy should be carried on.

Citation： WEN Shusheng, GAO Qiang, LI Xiaohua, ZAHO Junfei, CHEN Jimei, CEN Jianzheng, XU Gang, ZHUANG Jian. Cone reconstruction in the paitents with Ebstein's anomaly. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(1): 56-60. doi: 10.7507/1007-4848.201604066 Copy

1.	Ebstein W. Ueber einen sehr seltenen Fall von Insufficenz der Valvula tricuspidalis, bedingt durch eine angeborene hochgradige Missbildung derselben: Veit, 1866. 238-254.
2.	Lupo PJ, Langlois PH, Mitchell LE. Epidemiology of Ebstein anomaly: prevalence and patterns in Texas, 1999-2005. Am J Med Genet A, 2011, 155A(5): 1007-1014.
3.	Keith JD, Rowe RD PV, editors. Heart disease in infancy and children. New York: Macmillan Company,1958. 94-95.
4.	Boston US, Dearani JA, O'Leary PW, et al. Tricuspid valve repair for Ebstein's anomaly in young children: a 30-year experience. Ann Thorac Surg, 2006, 81(2): 690-696.
5.	Silva JPd, Baumgratz JF, Fonseca Ld, et al. Ebstein's anomaly: results of the conic reconstruction of the tricuspid valve. Arq Bras Cardiol, 2004, 82(3): 212-216.
6.	Knott-Craig CJ, Goldberg SP, Ballweg JA, et al. Surgical decision making in neonatal ebstein's anomaly: an algorithmic approach based on 48 consecutive neonates. World J Pediatr Congenit Heart Surg, 2012, 3(1): 16-20.
7.	Sata S, Murin P, Hraska V. Cone reconstruction of Ebstein's anomaly in a neonate. Ann Thorac Surg, 2012, 94(4): e99-100.
8.	Da Silva JP, Baumgratz JF, da Fonseca L, et al. The cone reconstruction of the tricuspid valve in Ebstein's anomaly. The operation: early and midterm results. J Thorac Cardiovasc Surg, 2007, 133(1): 215-23.
9.	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.
10.	Quaegebeur JM, Sreeram N, Fraser AG,et al. Surgery for Ebstein's anomaly: the clinical and echocardiographic evaluation of a new technique. J Am Coll Cardiol, 1991, 17(3): 722-728.
11.	Chen JM, Mosca RS, Altmann K, et al. Early and medium-term results for repair of ebstein anomaly. J Thorac Cardiovasc Surg, 2004, 127(4): 990-999.
12.	Vogel M, Marx GR, Tworetzky W, et al. Ebstein's malformation of the tricuspid valve: short-term outcomes of the "cone procedure" versus conventional surgery. Congenit Heart Dis, 2012, 7(1): 50-58.
13.	Prifti E, Baboci A, Kajo E, et al. The peacock tail technique: a modified reconstruction technique for tricuspid valve repair in Ebstein's malformation. Ann Thorac Surg, 2014, 97(6): e183-e185.
14.	Sano S, Fujii Y, Kasahara S, et al. Repair of Ebstein's anomaly in neonates and small infants: impact of right ventricular exclusion and its indications. Eur J Cardiothorac Surg, 2014, 45(3): 549-555.
15.	Chauvaud S, Fuzellier JF, Berrebi A, et al. Bi-directional cavopulmonary shunt associated with ventriculo and valvuloplasty in Ebstein's anomaly: benefits in high risk patients. Eur J Cardiothorac Surg, 1998, 13(5): 514-519.
16.	Vouhe PR. Management of neonatal Ebstein's anomaly: towards a rational approach? Eur J Cardiothorac Surg, 2014, 45(3): 556.
17.	Liu J, Qiu L, Zhu Z, et al. Cone reconstruction of the tricuspid valve in Ebstein anomaly with or without one and a half ventricle repair. J Thorac Cardiovasc Surg, 2011, 141(5): 1178-1183.
18.	Kopf GS, Laks H, Stansel HC, et al. Thirty-year follow-up of superior vena cava-pulmonary artery (Glenn) shunts. J Thorac Cardiovasc Surg, 1990, 100(5): 662-701.
19.	Attenhofer Jost CH, Connolly HM, Dearani JA, et al. Ebstein's anomaly. Circulation, 2007, 115(2): 277-285.
20.	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.

1. Ebstein W. Ueber einen sehr seltenen Fall von Insufficenz der Valvula tricuspidalis, bedingt durch eine angeborene hochgradige Missbildung derselben: Veit, 1866. 238-254.
2. Lupo PJ, Langlois PH, Mitchell LE. Epidemiology of Ebstein anomaly: prevalence and patterns in Texas, 1999-2005. Am J Med Genet A, 2011, 155A(5): 1007-1014.
3. Keith JD, Rowe RD PV, editors. Heart disease in infancy and children. New York: Macmillan Company,1958. 94-95.
4. Boston US, Dearani JA, O'Leary PW, et al. Tricuspid valve repair for Ebstein's anomaly in young children: a 30-year experience. Ann Thorac Surg, 2006, 81(2): 690-696.
5. Silva JPd, Baumgratz JF, Fonseca Ld, et al. Ebstein's anomaly: results of the conic reconstruction of the tricuspid valve. Arq Bras Cardiol, 2004, 82(3): 212-216.
6. Knott-Craig CJ, Goldberg SP, Ballweg JA, et al. Surgical decision making in neonatal ebstein's anomaly: an algorithmic approach based on 48 consecutive neonates. World J Pediatr Congenit Heart Surg, 2012, 3(1): 16-20.
7. Sata S, Murin P, Hraska V. Cone reconstruction of Ebstein's anomaly in a neonate. Ann Thorac Surg, 2012, 94(4): e99-100.
8. Da Silva JP, Baumgratz JF, da Fonseca L, et al. The cone reconstruction of the tricuspid valve in Ebstein's anomaly. The operation: early and midterm results. J Thorac Cardiovasc Surg, 2007, 133(1): 215-23.
9. 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.
10. Quaegebeur JM, Sreeram N, Fraser AG,et al. Surgery for Ebstein's anomaly: the clinical and echocardiographic evaluation of a new technique. J Am Coll Cardiol, 1991, 17(3): 722-728.
11. Chen JM, Mosca RS, Altmann K, et al. Early and medium-term results for repair of ebstein anomaly. J Thorac Cardiovasc Surg, 2004, 127(4): 990-999.
12. Vogel M, Marx GR, Tworetzky W, et al. Ebstein's malformation of the tricuspid valve: short-term outcomes of the "cone procedure" versus conventional surgery. Congenit Heart Dis, 2012, 7(1): 50-58.
13. Prifti E, Baboci A, Kajo E, et al. The peacock tail technique: a modified reconstruction technique for tricuspid valve repair in Ebstein's malformation. Ann Thorac Surg, 2014, 97(6): e183-e185.
14. Sano S, Fujii Y, Kasahara S, et al. Repair of Ebstein's anomaly in neonates and small infants: impact of right ventricular exclusion and its indications. Eur J Cardiothorac Surg, 2014, 45(3): 549-555.
15. Chauvaud S, Fuzellier JF, Berrebi A, et al. Bi-directional cavopulmonary shunt associated with ventriculo and valvuloplasty in Ebstein's anomaly: benefits in high risk patients. Eur J Cardiothorac Surg, 1998, 13(5): 514-519.
16. Vouhe PR. Management of neonatal Ebstein's anomaly: towards a rational approach? Eur J Cardiothorac Surg, 2014, 45(3): 556.
17. Liu J, Qiu L, Zhu Z, et al. Cone reconstruction of the tricuspid valve in Ebstein anomaly with or without one and a half ventricle repair. J Thorac Cardiovasc Surg, 2011, 141(5): 1178-1183.
18. Kopf GS, Laks H, Stansel HC, et al. Thirty-year follow-up of superior vena cava-pulmonary artery (Glenn) shunts. J Thorac Cardiovasc Surg, 1990, 100(5): 662-701.
19. Attenhofer Jost CH, Connolly HM, Dearani JA, et al. Ebstein's anomaly. Circulation, 2007, 115(2): 277-285.
20. 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.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Cone reconstruction in the paitents with Ebstein's anomaly

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