Correction of Ebstein’s Anomaly Using a Modified Carpentier’s Method_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HE Weilai , ZHOU Ruyuan , GE Shenglin

Department of Cardiovascular Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei230022, P.R.China;

Corresponding author：

Keywords：

Ebstein’s abnormality; Carpentier’s method; Surgery

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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.

Citation： HE Weilai,ZHOU Ruyuan,GE Shenglin,et al .. Correction of Ebstein’s Anomaly Using a Modified Carpentier’s Method. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(1): 22-25. doi: Copy

1.	van Noord PT, Scohy TV, McGhie J, et al. Three-dimensional transesophageal echocardiography in Ebstein’s anomaly. Interact Cardiovasc Thorac Surg，2010，10（5）：836-837.
2.	Bharucha T, Anderson RH, Lim ZS, et al. Multiplanar review of three-dimensional echocardiography gives new insights into the morphology of Ebstein’s malformation. Cardiol Young，2010，20（1）：49-53.
3.	谭林. Ebstein畸形的外科治疗进展.中国胸心血管外科临床杂志，2010，17（4）：326-329.
4.	Legius B, Van De Bruaene A, Van Deyk K, et al. Behavior of Ebstein’s　anomaly： single-center experience and midterm follow-up.　Cardiology，2010，117（2）：90-95.
5.	Cherry C, DeBord S, Moustapha-Nadler N. Ebstein’s anomaly： a complex congenital heart defect. AORN J，2009，89（6）：1098-1110.
6.	Carpentier A，Chauvaud S，Ma?e L，et al．A new reconstruetive operation for Ebstein’s anomaly of the tricuspid valve．J Thorac Cardiovasc Surg，1988，96（1）：92-101.
7.	Palmen M, de Jong PL, Klieverik LM, et al. Long-term follow-up after repair of Ebstein’s anomaly. Eur J Cardiothorac Surg，2008，34（1）：48-54.
8.	Sirivella S, Gielchinsky I. Surgery of the Ebstein’s anomaly： early and late outcomes. J Card Surg，2011，26（2）：227-233.
9.	Wu Q, Huang Z, Pan G, et al. Early and midterm results in anatomic repair of Ebstein anomaly. J Thorac Cardiovasc Surg，2007，134（6）：1438-1440.
10.	Boston US, Goldberg SP, Ward KE, et al. Complete repair of Ebstein anomaly in neonates and young infants： a 16-year follow-up. J Thorac Cardiovasc Surg，2011，141（5）：1163-1169.
11.	Sha JM, Yan ZY, Zhu ZY, et al. Early and midterm results of repair of Ebstein’s anomaly with autologous pericardium. Thorac Cardiovasc Surg，2011，59（5）：287-292.
12.	Bonilla-Palomas JL, López-Granados A, Gámez-López AL, et al. Severe right heart failure due to the combination of Ebstein’s anomaly and pericardial constriction. Rev Esp Cardiol， 2010，63（12）：1510-1511.
13.	叶生爱，陈振强，张辉，等. Edwards MC3成形环治疗中至重度三尖瓣反流.中国胸心血管外科临床杂志，2010，17（3）：239-241.
14.	Cho S, Kim WH, Kwak JG, et al. Right ventricular exclusion procedure for right ventricular failure of Ebstein’s anomaly. J Thorac Cardiovasc Surg，2009，138（5）：1246-1248.
15.	Palmen M, de Jong PL, Klieverik LM, et al. Long-term follow-up after repair of Ebstein’s anomaly. Eur J Cardiothorac Surg，2008，34（1）：48-54.
16.	Nagdyman N, Ewert P, Komoda T,et al. Modified repair in patients with Ebstein’s anomaly. J Heart Valve Dis，2010，19（3）：364-370.

1. 　van Noord PT, Scohy TV, McGhie J, et al. Three-dimensional transesophageal echocardiography in Ebstein’s anomaly. Interact Cardiovasc Thorac Surg，2010，10（5）：836-837.
2. 　Bharucha T, Anderson RH, Lim ZS, et al. Multiplanar review of three-dimensional echocardiography gives new insights into the morphology of Ebstein’s malformation. Cardiol Young，2010，20（1）：49-53.
3. 　谭林. Ebstein畸形的外科治疗进展.中国胸心血管外科临床杂志，2010，17（4）：326-329.
4. 　Legius B, Van De Bruaene A, Van Deyk K, et al. Behavior of Ebstein’s　anomaly： single-center experience and midterm follow-up.　Cardiology，2010，117（2）：90-95.
5. 　Cherry C, DeBord S, Moustapha-Nadler N. Ebstein’s anomaly： a complex congenital heart defect. AORN J，2009，89（6）：1098-1110.
6. 　Carpentier A，Chauvaud S，Ma?e L，et al．A new reconstruetive operation for Ebstein’s anomaly of the tricuspid valve．J Thorac Cardiovasc Surg，1988，96（1）：92-101.
7. 　Palmen M, de Jong PL, Klieverik LM, et al. Long-term follow-up after repair of Ebstein’s anomaly. Eur J Cardiothorac Surg，2008，34（1）：48-54.
8. 　Sirivella S, Gielchinsky I. Surgery of the Ebstein’s anomaly： early and late outcomes. J Card Surg，2011，26（2）：227-233.
9. 　Wu Q, Huang Z, Pan G, et al. Early and midterm results in anatomic repair of Ebstein anomaly. J Thorac Cardiovasc Surg，2007，134（6）：1438-1440.
10. 　Boston US, Goldberg SP, Ward KE, et al. Complete repair of Ebstein anomaly in neonates and young infants： a 16-year follow-up. J Thorac Cardiovasc Surg，2011，141（5）：1163-1169.
11. 　Sha JM, Yan ZY, Zhu ZY, et al. Early and midterm results of repair of Ebstein’s anomaly with autologous pericardium. Thorac Cardiovasc Surg，2011，59（5）：287-292.
12. 　Bonilla-Palomas JL, López-Granados A, Gámez-López AL, et al. Severe right heart failure due to the combination of Ebstein’s anomaly and pericardial constriction. Rev Esp Cardiol， 2010，63（12）：1510-1511.
13. 　叶生爱，陈振强，张辉，等. Edwards MC3成形环治疗中至重度三尖瓣反流.中国胸心血管外科临床杂志，2010，17（3）：239-241.
14. 　Cho S, Kim WH, Kwak JG, et al. Right ventricular exclusion procedure for right ventricular failure of Ebstein’s anomaly. J Thorac Cardiovasc Surg，2009，138（5）：1246-1248.
15. 　Palmen M, de Jong PL, Klieverik LM, et al. Long-term follow-up after repair of Ebstein’s anomaly. Eur J Cardiothorac Surg，2008，34（1）：48-54.
16. 　Nagdyman N, Ewert P, Komoda T,et al. Modified repair in patients with Ebstein’s anomaly. J Heart Valve Dis，2010，19（3）：364-370.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Correction of Ebstein’s Anomaly Using a Modified Carpentier’s Method

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