A técnica do cone para correção da anomalia de Ebstein: resultados imediatos e em longo prazo

Abstract

Background: The main Ebstein anomaly (EA) repairs are based on the monocusp reconstruction of the tricuspid valve and are limited by the frequent need for replacement or the high recurrence of valve regurgitation.

Anomalia de Ebstein

“…There were no complications such as atrioventricular block, and more significant residual lesions of tricuspid regurgitation were found in seven (17.5%) out of 40 patients analyzed in the long term, compared to 30% in Carpentier's technique 1 . Worthy of note is that the cone technique can be performed in all patients, regardless of valve anatomy, unlike Danielson's, in which it was possible to perform plastic surgery in only 27% of the 186 patients operated 1 .…”

“…Hence, the technique devised by da Silva et al 1 for the correction of this challenging heart disease, through the cone technique, as it is called, becomes a technical breakthrough of great magnitude and momentum in the overall handling of Ebstein's anomaly.…”

“…The cone technique has been under development since 1989 by da Silva et al 1 , and adds to other tricuspid valve plastic surgeries for correction of Ebstein's anomaly in a more favorable manner due to lower mortality (3.8%) compared to Danielson's (5.8%), Carpentier's (9%), and 13 institutions of the European Congenital Heart Surgery (13.3%) under various techniques 2 , delivering even better results, including in the long-term with respect to the need for reintervention, and good functionality of the tricuspid valve and right ventricle 1 .…”

“…Moreover, there is another aspect that should be further emphasized: the technique could be performed on younger patients than it is currently performed (18.5 ± 13.8 years), in order to be able to prevent adverse and unfavorable evolutionary aspects, such as marked right ventricular dilatation with consequent ventricular dysfunction, which becomes an element of progressive deterioration, even after proper plastic correction of the tricuspid valve, although there was no occurrence of these unfavorable elements that hindered further evolution, according to the authors 1 . In this context, even in the presence of these risk elements, the cone technique can be applied, according to Liu et al 4 in 30 of these patients, of which in 20 of them Glenn's bidirectional procedure was also employed concurrently (1,5 ventricle repair) vis-à-vis marked dilatation and right ventricular dysfunction, in an average age of 60 months (ranging from 2 to 192 months).…”

Ebstein’s Anomaly: “The One and a Half Ventricle Heart”

“…In recent years, many authors have published successful management of Ebstein's anomaly using biventricular approaches [19-21] . In our series, the residual RV after plication of ARV was 70% of the expected indexed RV volume, which precludes a biventricular repair.…”