Early and long-term results of surgical correction for Ebstein anomaly by cone reconstruction

Abstract

Objective. To evaluate the results of surgical correction of Ebstein anomaly by cone reconstruction in the early and late postoperative periods of observation. Material and Methods. The study included 35 patients with Ebstein anomaly aged 18 years and younger. The average age of patients was 5.5 [2; 10] years; weight was 23.4 [12.5; 27.5] kg; and height was 112.7 [90; 137] cm. All patients underwent surgical treatment for Ebstein anomaly by cone reconstruction, including four cases (11.4%) requiring the creation of a bidirectional cavopulmonary anastomosis. The echocardiographic parameters of the heart were studied in the preoperative, early postoperative, and long-term observation periods. The main emphasis was on the evaluation of tricuspid valve (TV) function indicators, including TV regurgitation degree, pressure gradient, Z-score, and size of the valve ring expressed as percentages of reference stature-weight values. The electrocardiographic records of patients were evaluated to analyze cardiac rhythm disturbances. The maximum period of observation was eight years. Results . The indexed sizes of the right atrium and right ventricle significantly decreased and the left ventricular end-diastolic index and stroke volume increased in the early postoperative period. In the long-term period of observation, there was an increase in the fibrous ring of TV ( p < 0.05), whereas the tricuspid pressure gradient and regurgitation did not change over time. Atrioventricular conduction disorders were not detected among patients in the early postoperative period. The bidirectional cavopulmonary anastomosis was created in the presence of the following conditions: the TV mean pressure gradient was more than 8 mmHg; the pressure gradient between the right and left atriums was above 1.5.