1. Anatomic Repair of Ebstein's Malformation: Lessons Learned With Cone Reconstruction 
Joseph A. Dearani, MD, Sameh M. Said, MD, Patrick W. O'Leary, MD, Harold M. Burkhart, MD, Roxann D. Barnes, MD, Frank Cetta, MD 
The Annals of Thoracic Surgery 
Volume 95, Issue 1, Pages (January 2013)
DOI: /j.athoracsur
Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Technique of tricuspid annular plication, which can be performed in a (A) single inferior site or (B) multiple anterior and inferior sites of the annulus. Multiple plication sites help to avoid an exaggerated plication in one location that could compromise the right coronary artery (RCA [arrow]).
Figure 1A adapted from Dearani et al [8] and used with permission of Mayo Foundation for Medical Education and Research.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
(A) The tricuspid annulus is usually dilated and a flexible annuloplasty ring is typically used. (B) However, in younger patients, a partial ring from the anteroinferior to inferoseptal commissures can be used, and serves to decease the stress on the repair and to support the reconstructed cone. (RCA = right coronary artery.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
(A) Reattachment of the septal leaflet (SL) should be done to the ventricular side of the conduction tissue (interrupted arrow), which is usually marked by a small vein (Vein of D). (B) Intraoperative photograph showing the reattachment of the completely mobilized tricuspid valve (TV) leaflets. (AL = anterior leaflet.)
Figure 3A adapted from Dearani et al [8] and used with permission of Mayo Foundation for Medical Education and Research.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
Tricuspid valve anterior leaflet augmentation can be performed using CorMatrix membrane or an autologous pericardial patch to increase the leaflet height and improve coaptation. Several small plications along the annular free edge of the leaflet can also be performed to increase the leaflet height.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

6. Fig 5
A triangular patch is may be used to augment the reconstructed cone to avoid tricuspid valve stenosis.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

7. Fig 6
(A, B) In case of absent choradae, surgically created neochordae can be made by performing several fenestrations apically in the linearly attached leaflet at the distal one third of the cone to allow unrestricted forward blood flow into the ventricle.
Adapted from Dearani et al [8] and used with permission of Mayo Foundation for Medical Education and Research.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions