Key result
Modified cone reconstruction combined with a bidirectional cavopulmonary shunt and tricuspid annuloplasty ring resulted in asymptomatic status for all 5 adult patients at up to 1 year follow-up, with 4 patients showing no to mild tricuspid regurgitation.
Why the study?
Does modified cone reconstruction combined with a bidirectional cavopulmonary shunt and tricuspid annuloplasty ring improve outcomes in adult patients with Ebstein anomaly?
Does modified cone reconstruction combined with a bidirectional cavopulmonary shunt and tricuspid annuloplasty ring improve outcomes in adult patients with Ebstein anomaly?
The routine addition of a bidirectional cavopulmonary shunt and tricuspid annuloplasty ring to modified cone reconstruction in adult patients with Ebstein anomaly is feasible and yields good early post-operative outcomes.
May support feasibility of combined cone repair in symptomatic adults; leaves open need for larger prospective studies.
Ebstein anomaly is an uncommon congenital cardiac disease affecting the tricuspid valve and right ventricle. Da silva pioneered the cone reconstruction of tricuspid valve for surgical repair of this anomaly in 2007. We describe our experience of 5 adult patients who underwent cone repair along with a bidirectional cavopulmonary shunt and tricuspid annuloplasty ring placement at our institute. Five adult patients with Ebstein anomaly with progressive disease and symptoms were taken up cone reconstruction from 2019 to 2021. Along with cone reconstruction of tricuspid valve, we routinely added an end to side superior vena cava to right pulmonary artery shunt and a tricuspid annuloplasty ring in the newly formed tricuspid annulus in all cases. All patients tolerated the procedure well and easily weaned off cardiopulmonary bypass. There were no complications regarding bidirectional cavopulmonary shunt and only one patient had a temporary heart block which was managed conservatively. This series shows routine addition of a cavopulmonary shunt and an annuloplasty ring improves outcomes and can be performed at other experienced cardiac surgery centres.
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Sharma et al. (2022) studied Ebstein anomaly (n=5). Modified cone reconstruction with bidirectional cavopulmonary shunt and tricuspid annuloplasty ring was evaluated on Postoperative clinical and echocardiographic outcomes. Modified cone reconstruction combined with a bidirectional cavopulmonary shunt and tricuspid annuloplasty ring resulted in asymptomatic status for all 5 adult patients at up to 1 year follow-up, with 4 patients showing no to mild tricuspid regurgitation.
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