Abstract： Objective To explore the clinical correction of Ebstein’s anomaly using a modified Carpentier’s method and summarize the clinical experience . Methods We retrospectively analyzed data for 13 consecutive patients（ 6 males and 7 females, with an age of 26.8±13.5 years） with Ebstein’s anomaly who underwent operation in the First Affiliated Hospital of Anhui Medical University between June 2006 and August 2010. All patients underwent correction using a modified Carpentier’s method. Operative techniques included excising and suturing the right atrialized chamber; puckering and shortening the tricuspid annulus；detaching the septal and posterior leaflet and/or part of the anterior leaflet from the displaced annulus; broadening and enlarging the area of the posterior/septal valve leaflet using autologous pericardium, and reattaching them to the true tricuspid annulus；transecting and reimplanting the papillary muscle and chordae; and simultaneously correcting any other congenital malformations. Results All patients survived and recovered well. The cardiac functional grading ranged from Ⅰ to Ⅱ (New York Heart Association ). All patients were followed up for 3 to 15 months (average 8 months). Postoperative echocardiograpy showed disappearance of tricuspid incompetence in 10 patients and mild or moderate tricuspid incompetence in 3 patients. The patients’ tricuspid valve leaflets were all at the normal level. At three months and at one year postoperation, rechecked echocardiograpy showed opening and closing of the tricuspid and right ventricular function recovering well, with no obvious incompetence in 12 patients, and moderate tricuspid incompetence lightened to mild in 1 patient. All patients returned to normal work and life. Conclusion Our technique for correcting Ebstein’s anomaly using a modified Carpentier’s method had satisfactory early results. The patients’ right ventricles were effectively reshaped and recovered function through excising and suturing the right atrialized chamber, and favorable tricuspid valvuloplasty effect was achieved by reattaching the enlarged leaflets using autologous pericardium to the true tricuspid annulus, and by transecting and reimplantating the papillary muscle and chordae.
Objective To improve surgical results, the experience of surgical management of Ebstein anomaly in 36 cases is reported and reviewed. Methods Surgical procedures included tricuspid valve replacement (6 cases), Danielson’s operation (28 cases), Carpentier’s operation (2 cases), among them, there were 5 cases of ablation of right atrioventricular accessory pathway. Results Four patients died early after operation in the hospital, 3 from right heart failure (1 case of tricuspid valve replacement and 2 cas...
The apical displacement of tricuspid valve leaflets complicated with significantly enlarged, thin and fibrotic wall of the right ventricle is prone to dysfunction of right heart. Therefore, the myocardial protection for the right ventricle is important. Based on the pathological changes, an algorithm of perioperative myocardial protection strategy is summarized. Firstly, we should clearly know that the right ventricular myocardium with severe lesions is much different from the unimpaired myocardium, because it is now on the margin of failure; secondly, right heart protection should be regarded as a systematic project, which runs through preoperative, intraoperative and postoperative periods, and requires close collaboration among surgeons, perfusionists, anesthesiologists and ICU physicians. In this article, we try to introduce the systematic project of the right heart protection, in order to improve the outcome of this population.
ObjectiveTo assess the method and the results of tricuspid annuloplasty performed(TVP) with the Edwards MC3 ring. MethodsWe retrospectively analyzed the clinical data of 312 patients with functional tricuspid regurgitation(FTR) secondary to left-sided valve disease in our hospital from June 2012 through May 2014. There were 147 males and 165 females at mean age of 55.7±7.3 years. ResultsThere was no death in the patients because of the planting of MC3 ring. The mean follow-up rate was 99.4%(310/312) for 2 patients immigration abroad. The follow-up time was 0-24(14.2±4.7) months. The ultrasoundcardiogram showed that all the ejection fraction(EF) of right ventricle improved compared with preoperation(P<0.05). The pulmonary artery systolic pressure(SPAP), both internal diameter and regurgitation volume of right ventricle were decreased(P<0.05). In the 310 patients, 302 patients(97.4%) were with the TR class 0-Ⅰ, 5 patients(1.6%) with class Ⅱ, 3 patients(1.0%) with class Ⅲ. There was no severe TR or no patient with reoperation. ConclusionThe MC3 ring is easy for planting and has good repeatability, which provides stable and satisfactory results for plasty of the tricuspid annulus with seldom residue or recurrent TR.
Objective To evaluate the efficacy of a combination of beating-heart minimally invasive approach and leaflets augmentation technique treating severe tricuspid regurgitation (TR) after cardiac surgery. Methods From January 2015 to August 2017, patients undergoing reoperative tricuspid valve repair (TVP) with minimally invasive approach and leaflets augmentation were enrolled. Cardiopulmonary bypass (CPB) was established via femoral vessels and the procedures were performed on beating heart with normothermic CPB. A bovine pericardial patch was sutured to leaflets to augment the native anterior and posterior leaflets. Other repair techniques, such as ring implantation and leaflet mobilization, were also applied as needed. Results A total of 28 patients (mean age 55.6±10.1 years, 5 males, 23 females) were enrolled. One patient was converted to median sternotomy due to pleural cavity adhesion. Twenty-seven patients underwent totally endoscopic TVP with leaflets augmentation. No patients was transferred to tricuspid valve replacement. Two patients died in hospital. All patients were followed up for 7.4±5.0 months and there was no late death and reoperation. Regurgitation area was converted from 20.7±10.1 cm2 to 3.3±3.3 cm2 after TVP according to the latest echocardiography (P<0.001). Conclusion Minimally TVP with leaflets augmentation is effective in treating severe isolated TR after primary cardiac surgery. It can significantly increase success rate of tricuspid valvuloplasty and decrease the surgical trauma.
ObjectiveTo analyze the clinical efficacy of transcatheter tricuspid valve replacement (TTVR) in cardiac implantable electronic lead-related tricuspid regurgitation (TR). MethodsThe patients with severe TR who underwent LuX-Valve TTVR in 9 Chinese medical centers from June 2020 to August 2021 were retrospectively enrolled. They were divided into a cardiac implantable electronic device (CIED) group and a non-CIED group based on whether they had pre-existing CIED implantation. Success of the procedure was defined as safe implantation of the LuX-Valve and complete withdrawal of the delivery system. Prognostic improvement was defined as a decrease of TR grade to≤2+ and an improvement of cardiac function by≥2 grades. Surgical success and postoperative prognosis were compared between the two groups. ResultsA total of 190 patients were collected, including 50 males and 140 females with a mean age of 66.2±7.8 years. There were 29 patients in the CIED group, and 161 patients in the non-CIED group. In the CIED group, 28 patients were implanted with a permanent pacemaker and 1 patient with a cardioverter-defibrillator. Preoperative New York Heart Association (NYHA) cardiac function class, TR degree, left ventricular ejection fraction, tricuspid annular plane systolic excusion, and cardiac risk scores were comparable between the two groups (P>0.05). Postoperative TR was reduced to≤2+ in all patients, and there was no statistical difference in the incidence of perivalvular leakage between the two groups (P=0.270). Postoperative CT of CIED patients showed the valve was in place, and the lead was not extruded, twisted, or deflected. The in-hospital mortality of the two groups were 10.3% and 1.9%, respectively, and the difference was statistically significant (P=0.047). In addition, there was no statistical difference between the two groups in terms of postoperative improvement of cardiac function and mortality in the 1- and 2-year follow-up. ConclusionTTVR is feasible, safe, and effective in patients with CIED implantation, and the pre-existing lead has no significant effect on the clinical efficacy.