Results of Valvuloplasty for Ebstein's Anomaly

Abstract

Sixteen patients, 8 males and 8 females were referred for surgery with the diagnosis of Ebstein's malformation of the tricuspid valve. The intervention was necessary because of deterioration of the clinical status. The age of the patients at the time of surgery ranged from 4 to 51 years. In 11 patients valvuloplasty was performed, in 5 patients the tricuspid valve was replaced with a bioprosthesis. One patient, with end-stage disease prior to surgery, died 2 days postoperatively rendering total mortality at 6.25%. Subsequent follow-up ranging from 8 months to 8 years was uneventful in the 15 survivors. Only 2 patients showed evidence of dysrhythmias, and demonstrated cardiothoracic ratios greater than 0.65. Cardiac catheterization in 3 patients, at one or 5 months postoperatively revealed normal pressure in the right heart. Provided the anterior tricuspid leaflet is of adequate size, surgical repair of Ebstein's anomaly through valvuloplasty appears to be feasible. The valvuloplasty consists of forming a monocusp valve with the anterior leaflet and plicating the atrialized portion of the right ventricle.

Combination of a Hetzer operation and a Sebening stitch for Ebstein's anomaly

“…The hinge point is made by placing a mattress suture between the body of the anterior leafl et and the ventricular septum on the opposite side (see Figs. 1 and 2), as described by Sebening et al 1 We made an additional hinge-point between the Sebening stitch and the mattress suture on the natural annulus in order to enhance the competence of the valve (see Figs. 1 and 3).…”

“…[1][2][3][5][6][7][8] The anterior leafl et is used as a monocusp valve in most of the repair techniques because the anterior leafl et is large in Ebstein's anomaly. The hinge point of the anterior leafl et in Ebstein's anomaly is usually on the natural annulus.…”

“…9 To obtain valve competence, most techniques use the same principle, i.e., the large anterior leafl et is essentially used as a functional monocusp valve. [1][2][3][5][6][7][8] However, when the mobility of the anterior leafl et is signifi cantly restricted, such as in type D of Carpentier's classifi cation, 7 the best way to obtain valve competence by repair is still a matter of discussion. 10 In order to increase valve competence even in such cases, we have introduced a modifi cation of our own technique, the Hetzer operation.…”

Early timing of surgical intervention in patients with Ebstein's anomaly predicts superior long-term outcome☆

“…Although methods of valve repair and replacement were performed since 1958, the reported outcomes were unsatisfactory, with a high early mortality [5][6][7]. Beginning with the 1970s, a significant improvement in life expectancy could be achieved with the development of various surgical techniques for valve repair [8][9][10][11][12][13].…”

Bioprosthetic valve replacement in Ebstein’s anomaly

“…On the other hand, in 1963, Barnard and Schrine reported the first successful treatment of two patients with Ebstein's anomaly by the insertion of a prosthetic valve [5]. Current surgical efforts are directed more towards tricuspid valve repair rather than replacement because of the known late problems of prosthetic valves [6][7][8][9][10]. However repair is a technically difficult procedure and it may not always be possible because of anatomic factors like insufficient valvular tissue or restricted leaflet mobility due to linear attachment of leading edge of anterior leaflet to ventricular myocardium.…”