EBSTEIN's ANOMALY: A FUNCTIONAL CONCEPT AND SUCCESSFUL DEFINITIVE REPAIR

Hardy, Kenneth J.; May, Ivan A.; Webster, Charles A.; Kimball, Kent G.

doi:10.1016/s0022-5223(19)33337-9

Cited by 132 publications

(25 citation statements)

References 33 publications

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“…Outcomes were less than optimal, resulting in high operative mortality and severe postoperative residual tricuspid valve incompetence. In 1964, Hardy introduced a technique of tricuspid valve repair based on the concept of Hunter and Lillehei . He emphasized the importance of “exclusion of the atralized ventricle” by relocating the displaced tricuspid leaflets to their normal plane and reducing the dilated annulus.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, vertical plication of the RV and reimplantation of the tricuspid valve leaflets were performed by Quaegebeur et al Recently, da Silva et al introduced a novel surgical technique (i.e., the cone procedure), which consists of the detachment and reattachment of displaced and tethered leaflets with reduction annuloplasty to form a funnel‐like inlet valve. Most of the repair techniques, however, address the abnormal tricuspid valve in a manner that the most mobile leaflet (usually the anterior leaflet) functions as a monocusp valve . Because the Carpentier technique or cone procedure requires extensive mobilization and untethering of the valve leaflet(s) from the tricuspid valve annulus and right ventricular free wall, an unsuccessful repair leads to unintended tricuspid valve replacement .…”

Section: Discussionmentioning

confidence: 99%

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Restoration of Tricuspid Valve Mechanism at the Level of Displaced Septal and Posterior Leaflets in Ebstein's Anomaly

Park

et al. 2016

J Card Surg

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Background: Surgical techniques currently used for the repair of Ebstein's anomaly comprise reconstruction of the tricuspid valve mechanism at the level of the true annulus with or without plication of the atrialized right ventricle. However, performing this procedure for patients with a dysmorphic anterior leaflet (i.e., insufficient leaflet tissue and decreased mobility due to tethering) may necessitate technical modifications. Methods: A retrospective review was performed of 31 patients (seven males and 24 females, median age at operation 31 years) with Ebstein's anomaly, who underwent tricuspid valve repair between March 2002 and December 2014. The original Hetzer technique (annulus to annulus approximation) was employed for six patients with a well-formed anterior leaflet. In 25 patients, the tricuspid valve mechanism was restored at the displaced septal leaflet by approximating the anterior leaflet attachment in the true annulus to the displaced septal leaflet attachment in the mid-septum. A bidirectional superior cavopulmonary anastomosis was added in 27 of 31 (87%) patients. Results: No early or late death occurred during the median follow-up of 66 months (1-138 months). Immediate postoperative tricuspid regurgitation was trivial to mild in 22 patients, and the median preoperative, immediate postoperative, and last follow-up tricuspid regurgitation jet areas in 21 adult patients were 23.3 cm 2 , 10.4 cm 2 , and 7.0 cm 2 , respectively. Two patients underwent reoperation at 81 and 119 months postoperatively. Five-year freedom from severe tricuspid regurgitation or reoperation was 93.2%. Conclusion: Restoration of the tricuspid valve mechanism at the level of displaced septal leaflet leads to excellent long-term outcomes. The addition of the bidirectional superior cavopulmonary anastomosis has contributed to the success of this technique.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Restoration of Tricuspid Valve Mechanism at the Level of Displaced Septal and Posterior Leaflets in Ebstein's Anomaly

Park

et al. 2016

J Card Surg

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“…Uma modificação técnica de plastia da valva tricúspide na correção da anomalia de Ebstein, tomando por base a técnica descrita por CARPENTIER et al (8) , foi realizada em seis pacientes adultos. Em princípio, as técnicas de plastia descritas na literatura estão sempre na dependência do tamanho e da mobilidade do folheto anterior (10)(11)(12)(13)(14)(15) .…”

Section: Comentáriosunclassified

“…O tratamento da anomalia de Ebstein é eminentemente cirúrgico e consiste na correção da disfunção valvar e correção dos defeitos associados quando coexistam. Atualmente, o defeito valvar é corrigido através de plastias e ou substituição valvar com ou sem plicatura longitudinal da porção atrializada do ventrículo direito, cujos resultados não são uniformes (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) . O objetivo do presente trabalho é avaliar os resultados obtidos com uma variação técnica de plastia da valva tricúspide, tomando-se por base a técnica utilizada por Carpentier (8) .…”

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Anomalia de Ebstein em paciente adulto: valvuloplastia modificada para correção de insuficiência tricúspide

Filho¹,

Maia²,

Rayol³

et al. 2002

Rev Bras Cir Cardiovasc

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Anomalia de Ebstein em paciente adulto: valvuloplastia modificada para correção de insuficiência tricúspide. Rev Bras Cir Cardiovasc 2002; 17(2): 24-28. RESUMO: Objetivos: Avaliar a correção cirúrgica em pacientes adultos portadores de anomalia de Ebstein, utilizando uma variação técnica para correção da insuficiência tricúspide.Casuística e Métodos: Entre janeiro de 1990 e março de 2001, seis pacientes adultos foram submetidos à correção cirúrgica com uma variação da técnica apresentada por Carpentier. A idade variou de 18 a 34 anos. Todos se apresentavam em classe funcional III ou IV (NYHA), com piora da cianose ou arritmias freqüentes. Em quatro pacientes a valva tricúspide era do tipo B e em dois do tipo A (Carpentier), quatro apresentavam comunicação interatrial (CIA) associada. O hematócrito variou de 33% a 68%. O índice cardíaco variou de 0.47 a 0.88. A fração de ejeção do ventrículo esquerdo variou de 50% a 80%.Resultados: Não se registrou óbitos no período hospitalar. Um paciente foi reoperado por sangramento no pós-operatório imediato. Em dois pacientes ocorreram derrames pericárdicos de repetição. Foi registrado um óbito no 14º mês de pós-operatório por morte súbita. Os pacientes foram seguidos por um período de 10 a 108 meses. Quatro encontram-se em classe funcional I e um encontra-se em classe funcional II (NYHA). O ecocardiograma no pós-operatório imediato e na última avaliação mostra insuficiência tricúspide discreta ou moderada em quatro e importante em um paciente.Conclusão: Apesar do pequeno número de pacientes nesta série, a modificação técnica cumpriu o seu papel, com a melhora clínica e funcional dos pacientes tratados em até nove anos de seguimento.

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“…Пионером в реконструкции клапана при АЭ можно считать K. Hardy, который в 1964 г. впервые выдвинул концепцию воссоздания клапана из собственных редуцированных тканей створок, а также предложил исключать атриализованную часть желудочка [28]. В нашей стране первую попытку выполнить пластику клапана предпринял Е.Н.…”

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Historical and modern aspects of surgical treatment of Ebstein’s anomaly

et al. 2020

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1 Научно-исследовательский институт (НИИ) кардиологии, Томский национальный исследовательский медицинский центр (НИМЦ) Российской академии наук Россия, 634012, г. Томск, ул. Киевская, 111а 2 Сибирский государственный медицинский университет (СибГМУ) Россия, 634050, г. Томск, Московский тракт, 2 РЕЗЮМЕ На сегодняшний день врожденные пороки сердца (ВПС) занимают одно из ведущих мест среди всей врожденной патологии. Частота ВПС достигает 2,4-14,2% на 1 000 новорожденных. Аномалия Эбштейна -редкая и сложная патология, клиническая картина которой может проявляться в любом возрасте. Медикаментозное лечение пациентов с ýтой патологией малоýффективно. Предпочтение в данном случае следует отдать хирургическому лечению. Для кардиохирурга важно знать основные методы коррекции ýтой патологии, их преимущества и недостатки.В литературном обзоре показана ýволюция методов хирургических коррекции аномалии Эбштейна с середины XX в. по настоящий момент. Дано описание хирургической техники основных способов пластики трикуспидального клапана, оказавших влияние на развитие хирургии аномалии Эбштейна. Ключевым моментом для успешной пластики клапана становится объем ткани створки, который возможно отделить от стенки правого желудочка. Приведен опыт выполнения протезирования и пластики трехстворчатого клапана. Наиболее многообещающим методом на сегодняшний день является «конусная» реконструкция. Таким образом, существует необходимость поиска новых методов и модификации уже имеющихся. Работы, направленные на их усовершенствование и устранение недостатков, являются перспективными.Ключевые слова: врожденные пороки сердца, аномалия Эбштейна, протезирование трикуспидального клапана, пластика трикуспидального клапана.Конфликт интересов. Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи.Источник финансирования. Авторы заявляют об отсутствии финансирования при проведении исследования.

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EBSTEIN's ANOMALY: A FUNCTIONAL CONCEPT AND SUCCESSFUL DEFINITIVE REPAIR

Cited by 132 publications

References 33 publications

Restoration of Tricuspid Valve Mechanism at the Level of Displaced Septal and Posterior Leaflets in Ebstein's Anomaly

Restoration of Tricuspid Valve Mechanism at the Level of Displaced Septal and Posterior Leaflets in Ebstein's Anomaly

Anomalia de Ebstein em paciente adulto: valvuloplastia modificada para correção de insuficiência tricúspide

Historical and modern aspects of surgical treatment of Ebstein’s anomaly

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