Ebstein's Anomaly of the Tricuspid Valve: The Cone Repair

Slides:

Advertisements

Similar presentations

The Rheumatic Mitral Valve and Repair Techniques in Children

Advertisements

Quantitative Real-Time Three-Dimensional Echocardiography Provides New Insight into the Mechanisms of Mitral Valve Regurgitation Post-Repair of Atrioventricular.

Volume 15, Issue 1, Pages (January 2012)

Benjamin B. Peeler, MD, Irving L. Kron, MD

International Journal of Cardiology

Sameh M. Said, Harold M. Burkhart, Joseph A. Dearani

Pulmonary Root Translocation for Anatomical Repair of Congenitally Corrected Transposition of the Great Arteries Jose Pedro da Silva, MD, Luciana Fonseca.

Valve-Sparing Aortic Root Replacement

Pedro J. del Nido, Christopher Baird

Pulmonary Valve Preservation Strategies for Tetralogy of Fallot Repair

Right ventricular papillary muscle approximation as a novel technique of valve repair for functional tricuspid regurgitation in an ex vivo porcine model

Tricuspid Valve Repair for Ebstein's Anomaly

Anatomic aspects of the atrioventricular junction influencing radiofrequency Cox maze IV procedures Manuel Castellá, MD, PhD, Antonio García-Valentín,

A technique for repair of partial anomalous pulmonary vein connection to the superior vena cava José Pedro da Silva, MD, Luciana da Fonseca da Silva,

Surgical Strategy Toward Biventricular Repair for Severe Ebstein Anomaly in Neonates and Infancy Shu-Chien Huang, MD, PhD, En-Ting Wu, MD, PhD, Shyh-Jye.

Valve-Sparing Options in Tetralogy of Fallot Surgery

Antonio Maria Calafiore, MD, Michele Di Mauro, MD

Surgically created double orifice repair of tricuspid regurgitation in infants with congenital heart disease Toyoki Fukuda, MD, Ichiro Kashima, MD, Shigeki.

Volume 15, Issue 1, Pages (January 2012)

The Relentless Effects of the Fontan Paradox

Benjamin B. Peeler, MD, Irving L. Kron, MD

Repair of Postinfarction Ventricular Septal Defect

Repair of primum ASD with cleft mitral valve

Dilated cardiomyopathy and functional mitral regurgitation complicated with traumatic ventricular septal defect Hisato Ito, MD, Kiyohito Yamamoto, MD,

Management of Neonatal Ebstein's Anomaly

Joseph A. Dearani, MD, Sameh M. Said, MD, Harold M

Kimberly A. Holst, MD, Joseph A. Dearani, MD, Sameh Said, MD, Roxann B

Early experience treating tricuspid valve endocarditis with a novel extracellular matrix cylinder reconstruction Marc W. Gerdisch, MD, W. Douglas Boyd,

The Rheumatic Mitral Valve and Repair Techniques in Children

Christopher J. Knott-Craig, MD, Steven P. Goldberg, MD, Edward D

Chordal Preservation in Mitral Valve Replacement

Volume 15, Issue 1, Pages (January 2012)

Tricuspid regurgitation as a result of Chiari network attachment

Joseph A. Dearani, MD, Sameh M. Said, MD, Patrick W

The cone reconstruction of the tricuspid valve in Ebstein’s anomaly

Ventricularization of the atrialized chamber: A concept of Ebstein's anomaly repair Michael V. Ullmann, MD, Sabine Born, MD, Christian Sebening, MD, Matthias.

Radiofrequency catheter ablation for drug-refractory paroxysmal atrial fibrillation in a patient with Ebstein’s anomaly Yong-Giun Kim, MD, Shin-Jae Kim,

Aortic Valve Insufficiency: Leaflet Reconstruction Techniques

Nikaidoh vs Réparation à l'Etage Ventriculaire vs Rastelli

Tricuspid Valve Repair in Single Ventricle: Timing and Techniques

Ebstein’s Anomaly Assessed by Real-Time 3-D Echocardiography

Intermediate-term results of a nonresectional dynamic repair technique in 662 patients with mitral valve prolapse and mitral regurgitation Gerald M.

Functional classification dictates type of repair in “complex” mitral insufficiency: Application to a case of a hammock mitral valve in an adult patient

Tricuspid Leaflet Augmentation to Eliminate Residual Regurgitation in Severe Functional Tricuspid Regurgitation Jong Bum Choi, MD, Nan Yeol Kim, MD,

Muralidhar Padala, BS, Nikolay V. Vasilyev, MD, James W

Anatomic repair of Ebstein's anomaly with isolated anterior leaflet downward displacement Qingyu Wu, MD, Guangyu Pan, MD, Hongyin Li, MD, Xiangchen Kong,

The long-term impact of various techniques for tricuspid repair in Ebstein's anomaly Roland Hetzer, MD, PhD, Paul Hacke, Mariano Javier, Oliver Miera,

Congenital absence of posteromedial papillary muscle and anterior mitral leaflet chordae: The use of three-dimensional echocardiography and approach in.

“Bow-Tie” mitral valve repair: An adjuvant technique for ischemic mitral regurgitation Juan P Umaña, MD, Bijan Salehizadeh, BA, Joseph J DeRose, MD, Tamanna.

Perforation of tricuspid pouch after tricuspid ring annuloplasty

Barlow disease: Simple and complex

Echocardiographic visualization and quantification of mitral complex during mitral repair for severe functional mitral regurgitation Kikuko Obase, MD,

Echocardiographic approach to the decision-making process for tricuspid valve repair Farideh Roshanali, MD, Bahare Saidi, MD, Mohammad Hossein Mandegar,

Effect of anterior strut chordal transection on the force distribution on the marginal chordae of the mitral valve Muralidhar Padala, PhD, Lazarina Gyoneva,

Antonio Maria Calafiore, MD, Michele Di Mauro, MD

Morphologic spectrum of ebstein's malformation: Revisitation relative to surgical repair Christian Schreiber, MD, Andrew Cook, BSc, Siew Yen Ho, PhD,

Repair of Ebstein’s anomaly in the symptomatic neonate: an evolution of technique with 7-year follow-up Christopher J. Knott-Craig, MD, Edward D. Overholt,

Hosam Fawzy, MD, Kiyotaka Fukamachi, MD, PhD, C

Repair of congenital tricuspid valve abnormalities with artificial chordae tendineae V.Mohan Reddy, MD, Doff B McElhinney, MD, Michael M Brook, MD, Norman.

Tricuspid Valve Repair for Functional Tricuspid Regurgitation

Cardiac arrhythmia in patients undergoing surgical repair of Ebstein’s anomaly Sylvain M Chauvaud, MD, Gianluca Brancaccio, MD, Alain F Carpentier, MD,

Gilles D. Dreyfus, MD, Pierre J. Corbi, MD, K. M

Right ventricular exclusion procedure for right ventricular failure of Ebstein's anomaly Sungkyu Cho, MD, Woong-Han Kim, MD, PhD, Jae Gun Kwak, MD, Chun.

P.Michael McFadden, John L Ochsner The Annals of Thoracic Surgery

Intraventricular mitral annuloplasty technique for use with repair of posterior left ventricular aneurysm Igor Konstantinov, MDa, Lynda L. Mickleborough,

Alternative Technique for the Ostium Primum Defect Repair: A Free Wall Flap of Right Atrium Massimo Massetti, MD, Gerard Babatasi, MD, Eugenio Neri,

Putting a Name on It: Ebstein's Anomaly

The arithmetic of a successful mitral valve repair

Management of tricuspid regurgitation in congenital heart disease: Is survival better with valve repair? Sameh M. Said, MD, Joseph A. Dearani, MD, Harold.

Early and medium-term results for repair of ebstein anomaly

Presentation transcript:

Ebstein's Anomaly of the Tricuspid Valve: The Cone Repair Jose Pedro da Silva, Luciana da Fonseca da Silva Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual Volume 15, Issue 1, Pages 38-45 (January 2012) DOI: 10.1053/j.pcsu.2012.01.008 Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 1 Preoperative magnetic resonance image of a 19-year-old woman with severe Ebstein's anomaly. The arrows point at abnormal papillary muscles and endocardial bands tethering the anterior leaflet of the TV to the anterior wall of the RV (A). The dotted line in B shows the aimed systolic position for the anterior leaflet after its extensive mobilization. Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 38-45DOI: (10.1053/j.pcsu.2012.01.008) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 2 Anterior and posterior leaflets of the TV mobilized as a single piece. A, Anterior and posterior leaflets anatomy (dotted line shows the displaced and the dashed line shows the true tricuspid annulus). B, Anterior leaflet mobilization. C, Section of posterior leaflet proximal connection to RV wall. D, The completely mobilized anterior and posterior leaflets. Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 38-45DOI: (10.1053/j.pcsu.2012.01.008) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 3 Anteroseptal commissure mobilization. A, An incision is made at the proximal attachment line of anterior leaflet continues anticlockwise (B), mobilizes the medial papillary muscle (C), and reaches the septal leaflet (D), which is mobilized as deep as possible. Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 38-45DOI: (10.1053/j.pcsu.2012.01.008) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 4 Septal leaflet Incorporation: A, A vertical suture joins the septal leaflet superior edge to the medial edge of the anterior leaflet. B and C, A second suture line unites the septal leaflet inferior edge to the lateral edge of the posterior leaflet. In cases with small septal leaflet it is combined with the completely detached posterior leaflet by a vertical suture (D), followed by a horizontal suture (E). V, vertical suture; H, horizontal suture. Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 38-45DOI: (10.1053/j.pcsu.2012.01.008) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 5 Cone attachment to true tricuspid annulus. The constructed cone (A) is reattached to the true tricuspid annulus starting at the anterior position (B) and completing the attachment (C), taking superficial bites when suturing near the atrioventricular node area (arrow). Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 38-45DOI: (10.1053/j.pcsu.2012.01.008) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 6 Cone construction done by rotation of the posterior leaflet, which was combined with the septal leaflet (A), before attachment to the true tricuspid annulus (B). AL, anterior leaflet; PL, posterior leaflet; SL, septal leaflet. Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 38-45DOI: (10.1053/j.pcsu.2012.01.008) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 7 Preoperative magnetic resonance images and intraoperative photos depicts the heart's anatomy of a 4-year-old girl with type D Ebstein's anomaly (Carpentier's classification). Images A, B, and C show that the TV leaflets are tethered to the RV wall and image D shows that there is only a small hole (H) communicating the atrialized to the functional RV. Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 38-45DOI: (10.1053/j.pcsu.2012.01.008) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 8 Tricuspid regurgitation degree: comparison of echocardiographic data in patients subjected to the cone repair of Ebstein's anomaly. It was shown significant improvement in tricuspid regurgitation when comparing early PO with preoperative data and no difference comparing early PO with late PO. Mean ± confidence interval of 95%. Preop, preoperative; PO, postoperative. Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 38-45DOI: (10.1053/j.pcsu.2012.01.008) Copyright © 2012 Elsevier Inc. Terms and Conditions