1. Surgical Strategy Toward Biventricular Repair for Severe Ebstein Anomaly in Neonates and Infancy
- Author
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Chi-Hsiang Huang, Yih-Sharng Chen, Jin-Chung Shih, Shyh-Jye Chen, En-Ting Wu, Hen-Wen Chou, Chung-I Chang, Ing-Sh Chiu, and Shu-Chien Huang
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Heart Ventricles ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Intracardiac injection ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Cardiac Surgical Procedures ,Tetralogy of Fallot ,Retrospective Studies ,Mechanical ventilation ,Tricuspid valve ,business.industry ,Infant, Newborn ,Infant ,Plastic Surgery Procedures ,medicine.disease ,Surgery ,Ebstein Anomaly ,Stenosis ,medicine.anatomical_structure ,Treatment Outcome ,030228 respiratory system ,Ventricle ,Practice Guidelines as Topic ,cardiovascular system ,Cardiology ,Female ,Right Ventricular Free Wall ,Cardiology and Cardiovascular Medicine ,business ,Shunt (electrical) ,Follow-Up Studies - Abstract
Background Neonates with severe forms of Ebstein anomaly present a surgical challenge, and the Starnes operation as single ventricle palliation is highly advocated. Cone reconstruction for tricuspid valvuloplasty (TVP) has become a widely accepted technique, although very few cases of TVP have been reported in neonates. This report describes a surgical strategy for neonatal Ebstein anomaly, with an aim toward biventricular repair. Methods Since 2007, 7 neonates or young infants with severe Ebstein anomalies have received TVP at the National Taiwan University Hospital, Taipei, Taiwan. The principle of cone reconstruction was applied with mobilization of all three leaflets and reattachment to the normal tricuspid annulus. The atrialized right ventricle was not plicated. In patients with pulmonary stenosis, the interatrial communication was not totally closed (n = 5), and a systemic-pulmonary shunt was added if needed (n = 3). Results All patients presented with intractable heart failure or severe cyanosis requiring mechanical ventilation, or both. All patients had marked adherence of the anterior leaflet to the right ventricular free wall. Intracardiac anomalies including ventricular septal defect (n = 2) and tetralogy of Fallot (n = 1) were also repaired simultaneously. Six of the 7 patients (86%) survived. There were no late deaths or repeat TVPs for a median follow-up of 4.3 years (range, 0.8 to 9.9 years). Conclusions Reconstruction of the tricuspid valve is an acceptable surgical strategy in patients with severe neonatal Ebstein anomaly. Fenestrated atrial septal defect and systemic-pulmonary shunt can help overcome anatomic pulmonary stenosis and high pulmonary resistance in the neonatal period. This surgical strategy has a good survival outcome and preserves the possibility of complete biventricular repair.
- Published
- 2016