Cone Reconstruction of the Tricuspid Valve in Children with Ebstein’s Anomaly

Denis S. Akatov ¹, Vyacheslav A. Belov ², Dina E. Khomich ², Andrey A. Makarov ², Sergey N. Kotov ², Nataliya V. Ganukova ², Yuriy A. Shneider ²

¹ The Federal Center of High Medical Technologies, Kaliningrad, Russia, Kaliningrad, Russia; ² The Federal Center of High Medical Technologies, Kaliningrad, Russia;

Date, time and location: 2018.05.26 13:30, Exhibition area, 1st Floor. Zone – D

Abstract

Objective: Ebstein's anomaly is a malformation of the tricuspid valve and right ventricle dysplasia and accounting for 1% of all cases of congenital heart disease. Cone Reconstruction (CR) was developed by Jose Pedro da Silva in 1989 and today CR is method of choice of surgical correction Ebstein's anomaly in many centers. We present our experience with the CR technique.

Methods: Between October 2015 and November 2017 we performed 18 CR procedures for patients with Ebstein's anomaly. 13 patients of them were operated at our center in 2017. The median age was 75 months (range, 7 months –17 years). Tricuspid incompetence was severe or total in all cases before operation.

Results: Plication of atrialized part of the right ventricle was performed in 13 patients (72.2%). Bidiractional cavopulmonary anastomosis was necessary in 7 cases. CR procedure with reconstruction of posterior leaflet of tricuspid valve with xenopericardial patch was performed in 1 case and tricuspid augmentation with autopericardial patch was included in 2 patients. No valve replacement was necessary. Tricuspid regurgitation was minimal in 15 patients (83.3%) or moderate in 3 patients (16.7%) after operation. No tricuspid stenosis was presented in our patients. One patient required permanent pacemaker. There were no hospital deaths in our hospital. Follow-up information was available for 15 patients (mean 9.7 months; longest follow-up 23.3 months). There were no late deaths. Reoperation was required in 1 patient because of severe tricuspid regurgitation. He was underwent repeat valve repair at the second postoperative month.

Conclusion: Cone Reconstruction for Ebstein’s anomaly can be performed with low morbidity and mortality. The changes in RV function after CR requires further analyze in follow-up for a better understanding of the advantages of the technique.