Rüdiger Lange1, Melchior Burri2, Lena Katharina Eschenbach2, Catalin Constantin Badiu2, José Pedro da Silva3, Nicole Nagdyman4, Sohrab Fratz4, Jürgen Hörer2, Andreas Kühn4, Christian Schreiber2, Manfred Otto Vogt4. 1. Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany DZHK (German Center for Cardiovascular Research)-partner site Munich Heart Alliance, Munich, Germany lange@dhm.mhn.de. 2. Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany. 3. Cardiovascular Surgery Division, Hospital Beneficencia Portuguesa de São Paulo Escola Paulista de Medicina-UNIFESP, São Paulo, Brazil. 4. Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich at the Technical University Munich, Munich, Germany.
Abstract
OBJECTIVES: Da Silva's cone repair is a novel technique for surgical reconstruction of the tricuspid valve and the right ventricle (RV) in Ebstein's anomaly. The technique consists of extensive leaflet mobilization, longitudinal plication of the atrialized ventricle and cone-shaped reconstruction of the tricuspid valve, allowing for leaflet-to-leaflet coaptation. We evaluated the influence of Da Silva's cone repair on tricuspid competency, right ventricular size and function. METHODS: From February 2010 until July 2013, 20 patients (median age 30.0 years, range 6.6-68.3 years) underwent Da Silva's cone repair. A 4- to 6-mm interatrial communication was left in all patients. Echocardiographic studies and magnetic resonance imaging (MRI) before and after the repair were evaluated. RESULTS: Median follow-up was 11 (0.5-36) months. There were 2 early deaths and no late death. Echocardiography at follow-up revealed mild or absent tricuspid regurgitation in 16 patients. Two patients showed moderate tricuspid insufficiency. MRI studies showed that the mean functional RV end-diastolic volume decreased after surgery (pre 334 [135-656] ml; post 175 [115-404] ml, P < 0.001). The mean RV ejection fraction decreased (pre 47 ± 10%; post 35 ± 13%, P = 0.001), and the mean antegrade net stroke volume of the RV increased (pre 65 ± 28 ml; post 75 ± 30 ml, P = 0.057). CONCLUSIONS: Da Silva's cone repair for Ebstein's anomaly creates excellent valve function in all patients. Consecutively, the size of the RV decreases and the antegrade net stroke volume increases 6 months after the operation.
OBJECTIVES: Da Silva's cone repair is a novel technique for surgical reconstruction of the tricuspid valve and the right ventricle (RV) in Ebstein's anomaly. The technique consists of extensive leaflet mobilization, longitudinal plication of the atrialized ventricle and cone-shaped reconstruction of the tricuspid valve, allowing for leaflet-to-leaflet coaptation. We evaluated the influence of Da Silva's cone repair on tricuspid competency, right ventricular size and function. METHODS: From February 2010 until July 2013, 20 patients (median age 30.0 years, range 6.6-68.3 years) underwent Da Silva's cone repair. A 4- to 6-mm interatrial communication was left in all patients. Echocardiographic studies and magnetic resonance imaging (MRI) before and after the repair were evaluated. RESULTS: Median follow-up was 11 (0.5-36) months. There were 2 early deaths and no late death. Echocardiography at follow-up revealed mild or absent tricuspid regurgitation in 16 patients. Two patients showed moderate tricuspid insufficiency. MRI studies showed that the mean functional RV end-diastolic volume decreased after surgery (pre 334 [135-656] ml; post 175 [115-404] ml, P < 0.001). The mean RV ejection fraction decreased (pre 47 ± 10%; post 35 ± 13%, P = 0.001), and the mean antegrade net stroke volume of the RV increased (pre 65 ± 28 ml; post 75 ± 30 ml, P = 0.057). CONCLUSIONS: Da Silva's cone repair for Ebstein's anomaly creates excellent valve function in all patients. Consecutively, the size of the RV decreases and the antegrade net stroke volume increases 6 months after the operation.
Authors: Christian Meierhofer; Andreas Kühn; Jan Müller; Nerejda Shehu; Alfred Hager; Stefan Martinoff; Heiko Stern; Peter Ewert; Manfred Vogt Journal: Pediatr Cardiol Date: 2019-02-06 Impact factor: 1.655
Authors: Jelena Pabst von Ohain; Eleonora Tonino; Harald Kaemmerer; Julie Cleuziou; Peter Ewert; Rüdiger Lange; Jürgen Hörer Journal: Cardiovasc Diagn Ther Date: 2021-04