Application of Cone Reconstruction for Neonatal Ebstein Anomaly or Tricuspid Valve Dysplasia

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• 作者：Masanori Mizuno ; MD ; PhD^a ; Takaya Hoashi ; MD ; PhD^b ; ^{thoashi@surg1.med.osaka-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Heima Sakaguchi ; MD ; PhD^a ; Koji Kagisaki ; MD^b ; Masataka Kitano ; MD^a ; Kenichi Kurosaki ; MD^a ; Jun Yoshimatsu ; MD ; PhD^c ; Isao Shiraishi ; MD ; PhD^a ; Hajime Ichikawa ; MD ; PhD^b
• 关键词：&ndash ; no ; + ; yes ; AAD ; antiarrhythmic drugs ; APF ; antegrade pulmonary flow ; bi ; bicuspidized ; BVR ; biventricular repair ; CFPD ; continuous-flow peritoneal dialysis ; CI ; cardiac index ; CPB ; cardiopulmonary bypass ; CTR ; cardiothoracic ratio ; CVP ; central venous pressure ; DIC ; disseminated intravascular coagulation ; EA ; Ebstein anomaly ; ECLS ; extracorporeal life support ; LOS ; low output syndrome ; LVDd ; left ventricular end-diastolic diameter ; LVEF ; left ventricular ejection fraction ; NEC ; necroti
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：101
• 期：5
• 页码：1811-1817
• 全文大小：467 K

文摘

Outcomes of surgical intervention for severe tricuspid regurgitation related to Ebstein anomaly or tricuspid valve dysplasia in the neonatal period, particularly when associated with pulmonary atresia, are extremely poor. However, owing to emerging innovative surgical techniques, such as cone reconstruction, outcomes of tricuspid valve plasty in the neonatal period have gradually improved.

Methods

The study retrospectively reviewed the medical records of 12 neonates who were diagnosed with severe tricuspid regurgitation and pulmonary atresia related to Ebstein anomaly (n = 9) or isolated tricuspid valve dysplasia (n = 3) between 2000 and 2013.

Results

The first 6 patients underwent palliative therapy in anticipation of future functional single-ventricle palliation (Starnes operation). Biventricular repair was performed in the 6 patients born after 2012. As tricuspid valve plasty, cone reconstruction has been applied since 2013. Five patients underwent a Starnes operation, and 5 patients underwent biventricular repair, including 4 cone reconstructions. Four of the 5 patients who underwent a Starnes operation died in-hospital; the remaining patient underwent a Fontan operation at age 2 years. Three of the 5 patients who underwent biventricular repair survived. On echocardiogram, the 3 survivors who were treated with biventricular repair had a preoperative tricuspid regurgitation flow velocity greater than 3.0 m/s.

Conclusions

Biventricular repair with cone reconstruction can be applied for severe tricuspid regurgitation due to neonatal Ebstein anomaly or tricuspid valve dysplasia with associated pulmonary atresia. A tricuspid regurgitation flow velocity greater than 3.0 m/s may be an indicator of successful biventricular repair.