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Surgical Strategy Toward Biventricular Repair for Severe Ebstein Anomaly in Neonates and Infancy
- Source :
- The Annals of thoracic surgery. 104(3)
- Publication Year :
- 2016
-
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.
- 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
Subjects
Details
- ISSN :
- 15526259
- Volume :
- 104
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- The Annals of thoracic surgery
- Accession number :
- edsair.doi.dedup.....ace230c0873b86c9f9fc512ee39dda74