A Successful Surgical Treatment of Ebstein^|^apos;s Anomaly by Hetzer^|^apos;s Procedure in an Adult

Abstract

A Successful Surgical Treatment of Ebsteinʼs Anomaly by Hetzerʼs Procedure in an AdultMitsutaka Nakao, Kiyozou Morita, Yoshihiro Ko, Takayuki Abe and Kazuhiro Hashimoto（Department of Cardiac Surgery, Jikei University School of Medicine, Tokyo, Japan） A 29-year-old woman, who had been diagnosed with Ebsteinʼs anomaly associated with paroxysmal supraventricular tachycardia due to Wolff-Parkinson-White（WPW）syndrome, was referred to our hospital for treatment of congestive heart failure and tachycardia. She had undergone a catheter ablation for WPW syndrome at the age of 28 years. Subsequently, surgical treatment for Ebsteinʼs anomaly was indicated because of persistent symptoms of heart failure due to tricuspid regurgitation（TR). The echocardiogram and pathologic findings corresponded to Ebsteinʼs anomaly of the Carpentier type B classification, with severe displacement of the septal and posterior leaflets resulting in moderate TR. A mobile anterior leaflet of sufficient size without a cleft enabled us to successfully perform Hetzerʼs procedure. In this procedure, the large mobile anterior leaflet was approximated to the opposing true tricuspid annulus with a mattress suture of 3-0 polypropylene passed from the anterior leaflet annulus to the true tricuspid annulus at the site of atrialized right ventricle near the coronary sinus. The postoperative course was uneventful, and the cardiothoracic ratio reduced from 56% to 48% with mild TR. In this adult case of Carpentierʼs type B adult Ebsteinʼs anomaly, Hetzerʼs procedure allowed reconstruction of the tricuspid valve mechanism of "leaflet-to-septum" coaptation at the level of the true annulus by approximating the anterior leaflet. This was, effective in reducing the patientʼs moderate TR. We conclude that this procedure is a simple and reproducible method for repairing the tricuspid valve in Ebsteinʼs anomaly, especially for cases with a large mobile anterior leaflet.