Reemplazo Valvular Tricuspídeo con Válvula Cilíndrica de Matriz Extracelular en Anomalía de Ebstein: Reporte de Caso y Revisión de la Técnica

Reemplazo Valvular Tricuspídeo con Válvula Cilíndrica de Matriz ExtracelularTricuspid valve reemplacement using a cilyndric extra cellular matrix valve in a patient with Ebstein anomaly Ebstein's Anomaly represents a major surgical challenge due to its extreme anatomical variability.The Cone technique is the current gold standard; however, in patients with severe valvular dysplasia or failed prior repair, valve replacement becomes imperative.Conventional bioprostheses carry significant limitations in pediatric patients, including accelerated structural degeneration and obstructive gradients that cannot accommodate somatic growth.We report the case of a 9-year-old female with severe Ebstein anomaly, presenting near-complete absence of septal and posterior leaflet tissue, who underwent Cone repair with 1½ ventricle physiology.Immediate postoperative results were suboptimal, with a persistent tricuspid gradient of 7 mmHg and mild-tomoderate regurgitation, prompting early reoperation.Tricuspid valve replacement was performed using a tailored extracellular matrix (ECM) cylinder (Proxi-cor™), anchored to the subvalvular apparatus at three points separated by 120° and secured to the native tricuspid annulus.Intraoperative echocardiography demonstrated a mean inflow gradient of 3 mmHg with mild regurgitation.At follow-up, the patient remains asymptomatic with recovered right ventricular function (EF 47%) and a competent neovalve.This case demonstrates that the ECM cylindrical valve is a viable and hemodynamically effective alternative in Ebstein anomaly with unfavorable anatomy, providing early evidence from Latin America on its applicability in pediatric congenital cardiac surgery.This case demonstrates that the ECM cylindrical valve is a viable and hemodynamically effective alternative in Ebstein anomaly with unfavorable anatomy, providing early evidence from Latin America on its applicability in pediatric congenital cardiac surgery.