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,

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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, MD, Kent E. Ward, MD, Jeremy M. Ringewald, MD, Sherri S. Baker, MD, Jerry D. Razook, MD  The Annals of Thoracic Surgery  Volume 73, Issue 6, Pages 1786-1793 (June 2002) DOI: 10.1016/S0003-4975(02)03507-5

Fig 1 Orientation of tricuspid valve orifice in Ebstein’s anomaly: X is toward the right ventricular apex; Y is toward the right ventricular outflow tract. The Annals of Thoracic Surgery 2002 73, 1786-1793DOI: (10.1016/S0003-4975(02)03507-5)

Fig 2 With a large mobile anterior leaflet, a lateral annuloplasty can be done either by bringing the suture from A to B as shown and vertically plicating the lateral wall (Danielson-type annuloplasty) or by doing a DeVega-type annuloplasty suture from A up to B. The Annals of Thoracic Surgery 2002 73, 1786-1793DOI: (10.1016/S0003-4975(02)03507-5)

Fig 3 Fenestrated atrial septal defect closure is shown. Pledgetted sutures drag the anterior papillary muscle closer to the septal leaflet to improve coaption. The anterior and posterior leaflets may need to be detached along the annulus from A to B. The anteroseptal commissure and leaflet may need to be fenestrated (C to D). The Annals of Thoracic Surgery 2002 73, 1786-1793DOI: (10.1016/S0003-4975(02)03507-5)

Fig 4 Once detached from the annulus, the anterior leaflet is freed from the underlying muscle ridges at the os infundibuli level, and the annulus is reduced (A to B). The Annals of Thoracic Surgery 2002 73, 1786-1793DOI: (10.1016/S0003-4975(02)03507-5)

Fig 5 When the leaflets are reattached, the leaflets are effectively rotated counterclockwise relative to the annulus, changing the orientation of the orifice to point towards the outflow tract. The vertical plication is completed, obliterating the atrialized portion of the right ventricle. The Annals of Thoracic Surgery 2002 73, 1786-1793DOI: (10.1016/S0003-4975(02)03507-5)