Abstract
I read with great interest the article by Chen and colleagues1Chen J.M. Mosca R.S. Altmann K. Printz B.F. Targoff K. Mazzeo P.A et al.Early and medium-term results for repair of Ebstein anomaly.J Thorac Cardiovasc Surg. 2004; 127: 990-999Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar “Early and Medium-Term Results for Repair of Ebstein Anomaly.” The results are superb, without hospital mortality and with improvement of the functional condition. The technique proved to be reproducible. It seems from previous studies2Celermajer D.S. Bull C. Till J.A. Cullen S. Vassillikos V. Sullivan I.D et al.Ebstein's anomaly: presentation and outcome from fetus to adult.J Am Coll Cardiol. 1994; 23: 170-176Abstract Full Text PDF PubMed Scopus (334) Google Scholar that the Ebstein anomaly is a combination of ventricular and valvular disease. This concept has led my group to develop the use of an associated bidirectional cavopulmonary shunt in severe cases.3Chauvaud S. Fuzellier J.F. Berrebi A. Lajos P. Marino J.P. Mihaileanu S et al.Bi-directional cavopulmonary shunt associated with ventriculo and valvuloplasty in Ebstein's anomaly: benefits in high risk patients.Eur J Cardiothorac Surg. 1998; 13: 514-519Crossref PubMed Scopus (75) Google Scholar I was surprised by the preoperative right ventricular ejection function, which was normal in all cases except 1 in Dr Chen's series, without quantified data. My first concern is to know what is meant by the right ventricle. Is it the effective right ventricle below the attachment of the valve or the right ventricle with the atrialized right ventricle? In most of the patients on whom my own group has operated, the right anterior wall was dilated and hypokinetic.4Chauvaud S. Berrebi A. d'Attellis N. Mousseaux E. Hernigou A. Carpentier A. Ebstein's anomaly: repair based on functional analysis.Eur J Cardiothorac Surg. 2003; 23: 525-531Crossref PubMed Scopus (89) Google Scholar I am interested to know whether this aspect was present in Chen and colleagues' series.1Chen J.M. Mosca R.S. Altmann K. Printz B.F. Targoff K. Mazzeo P.A et al.Early and medium-term results for repair of Ebstein anomaly.J Thorac Cardiovasc Surg. 2004; 127: 990-999Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar The postoperative decrease of right ventricular ejection fraction could be due to the section of abnormal muscular trabeculations. It is in my mind an additional reason to decrease the preload of the right ventricle with a partial Glenn procedure. ReplyThe Journal of Thoracic and Cardiovascular SurgeryVol. 128Issue 5PreviewMy coauthors and Iare in agreement with Dr Chauvaud's impression that the Ebstein anomaly is a combination of ventricular and valvular disease. In our study, the right ventricle, as analyzed by transthoracic echocardiography, was considered to be the effective right ventricle below the attachment of the valve. In several patients—most notably the adults—the right anterior wall was indeed hypokinetic. Care certainly must be taken not to assign hypokinetic areas of atrialized ventricle to the true right ventricle. Full-Text PDF
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