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

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Anatomic repair of Ebstein's anomaly with isolated anterior leaflet downward displacement Qingyu Wu, MD, Guangyu Pan, MD, Hongyin Li, MD, Xiangchen Kong, MD Candidate The Journal of Thoracic and Cardiovascular Surgery Volume 148, Issue 4, Pages 1454-1458.e1 (October 2014) DOI: 10.1016/j.jtcvs.2014.02.075 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Imaging examination. A, Preoperative chest x-ray shows a significantly enlarged right heart. B and C, Preoperative UCG. 1. Anterior tricuspid leaflet. 2. Septal tricuspid leaflet. D, Postoperative chest x-ray shows significantly reduced heart size. E and F, Postoperative UCG shows normal-sized right atrium and right ventricle with no notable tricuspid insufficiency. aRV, Atrialized right ventricle; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; TI, tricuspid insufficiency. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 1454-1458.e1DOI: (10.1016/j.jtcvs.2014.02.075) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Huge, thin-walled atrialized right ventricle. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 1454-1458.e1DOI: (10.1016/j.jtcvs.2014.02.075) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Procedure: A1 and A2, After atrialized right ventricle excision. A1, 1, Huge “V”-shaped defect left by atrialized right ventricle excision; 2, anterior tricuspid leaflet (mostly detached); 3, coronary sinus. B, “V” defect and anterior leaflet repair. C1 and C2, Increased septal leaflet area. C1, 1, Suture of the “V”-shaped defect to reconstruct the right ventricular anterior wall and TV annulus; 2, enlarged septal leaflet with autologous pericardium; 3, coronary sinus. D, Completed procedure. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 1454-1458.e1DOI: (10.1016/j.jtcvs.2014.02.075) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Reestablished right atrioventricular connection. 1, Ascending aorta. 2, Right atrial incision (closed). 3, Reestablished right atrioventricular connection. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 1454-1458.e1DOI: (10.1016/j.jtcvs.2014.02.075) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Protecting the extended RCA. 1, Ascending aorta. 2, Fix the extended RCA. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 1454-1458.e1DOI: (10.1016/j.jtcvs.2014.02.075) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions