1. 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 (January 2012)
DOI: /j.pcsu
Copyright © 2012 Elsevier Inc. Terms and Conditions

2. 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  , 38-45DOI: ( /j.pcsu )
Copyright © 2012 Elsevier Inc. Terms and Conditions

3. 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  , 38-45DOI: ( /j.pcsu )
Copyright © 2012 Elsevier Inc. Terms and Conditions

4. 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  , 38-45DOI: ( /j.pcsu )
Copyright © 2012 Elsevier Inc. Terms and Conditions

5. 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  , 38-45DOI: ( /j.pcsu )
Copyright © 2012 Elsevier Inc. Terms and Conditions

6. 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  , 38-45DOI: ( /j.pcsu )
Copyright © 2012 Elsevier Inc. Terms and Conditions

7. 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  , 38-45DOI: ( /j.pcsu )
Copyright © 2012 Elsevier Inc. Terms and Conditions

8. 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  , 38-45DOI: ( /j.pcsu )
Copyright © 2012 Elsevier Inc. Terms and Conditions

9. 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  , 38-45DOI: ( /j.pcsu )
Copyright © 2012 Elsevier Inc. Terms and Conditions