Thorac Cardiovasc Surg 2017; 65(08): 639-648
DOI: 10.1055/s-0037-1604469
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Surgical Treatment of Ebstein's Anomaly

Melchior Burri
1   Clinic for Cardiovascular Surgery, German Heart Centre Munich at the Technical University, Munich, Germany
,
Rüdiger Lange
1   Clinic for Cardiovascular Surgery, German Heart Centre Munich at the Technical University, Munich, Germany
2   DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
› Author Affiliations
Further Information

Publication History

30 March 2017

13 June 2017

Publication Date:
14 August 2017 (online)

Abstract

Surgical repair of the tricuspid valve is a milestone in the medical history of patients with Ebstein's anomaly. The timely alleviation of the insufficiency has an important impact on the prognosis. In this review, we describe features of the disease relevant to surgical correction and the evolution of surgical techniques over six decades. We compare the results of different repair and replacement techniques. Additionally, we discuss concomitant antiarrhythmic surgery and bailout strategies for postoperative right ventricular failure. Finally, we review the surgical options in symptomatic neonates with Ebstein's disease.

 
  • References

  • 1 Correa-Villaseñor A, Ferencz C, Neill CA, Wilson PD, Boughman JA. ; The Baltimore-Washington Infant Study Group. Ebstein's malformation of the tricuspid valve: genetic and environmental factors. Teratology 1994; 50 (02) 137-147
  • 2 Anderson KR, Lie JT. The right ventricular myocardium in Ebstein's anomaly: a morphometric histopathologic study. Mayo Clin Proc 1979; 54 (03) 181-184
  • 3 Edmar A. Case 1/2015 A 76-year-old male patient with ebstein anomaly in natural course. Arquivos brasileiros de cardiologia 2015; 104 (01) e1-e3
  • 4 Ebstein W. Über einen sehr seltenen Fall von Insufficienz der Valvula tricuspidalis, bedingt durch eine angeborene hochgradige Missbildung derselben. Archiv Für Anatomie, Physiologie Und Wissenschaftliche Medicin 1866: 238-254
  • 5 Soloff LA, Stauffer HM, Zatuchni J. Ebstein's disease: report of the first case diagnosed during life. Am J Med Sci 1951; 222 (05) 554-561
  • 6 Burchell HB, Dushane JW, Kilby RA, Wood EH. Ebstein's malformation: a clinical and laboratory study. Medicine (Baltimore) 1956; 35 (03) 161-185
  • 7 Hunter SW, Lillehei CW. Ebstein's malformation of the tricuspid valve; study of a case together with suggestion of a new form of surgical therapy. Dis Chest 1958; 33 (03) 297-304
  • 8 Hardy KL, May IA, Webster CA, Kimball KG. Ebstein's anomaly: a functional concept and successful definitive repair. J Thorac Cardiovasc Surg 1964; 48: 927-940
  • 9 Barnard CN, Schrire V. Surgical correction of ebstein's malformation withprosthetic tricuspid valve. Surgery 1963; 54: 302-308
  • 10 Van Mierop LH, Gessner IH. Pathogenetic mechanisms in congenital cardiovascular malformations. Prog Cardiovasc Dis 1972; 15 (01) 67-85
  • 11 Schreiber C, Cook A, Ho SY, Augustin N, Anderson RH. Morphologic spectrum of Ebstein's malformation: revisitation relative to surgical repair. J Thorac Cardiovasc Surg 1999; 117 (01) 148-155
  • 12 Fratz S, Janello C, Müller D. , et al. The functional right ventricle and tricuspid regurgitation in Ebstein's anomaly. Int J Cardiol 2013; 167 (01) 258-261
  • 13 Lange R, Burri M, Eschenbach LK. , et al. Da Silva's cone repair for Ebstein's anomaly: effect on right ventricular size and function. Eur J Cardiothorac Surg 2015; 48 (02) 316-320 ; discussion 320–321
  • 14 Anderson KR, Zuberbuhler JR, Anderson RH, Becker AE, Lie JT. Morphologic spectrum of Ebstein's anomaly of the heart: a review. Mayo Clin Proc 1979; 54 (03) 174-180
  • 15 Daliento L, Angelini A, Ho SY. , et al. Angiographic and morphologic features of the left ventricle in Ebstein's malformation. Am J Cardiol 1997; 80 (08) 1051-1059
  • 16 Celermajer DS, Dodd SM, Greenwald SE, Wyse RK, Deanfield JE. Morbid anatomy in neonates with Ebstein's anomaly of the tricuspid valve: pathophysiologic and clinical implications. J Am Coll Cardiol 1992; 19 (05) 1049-1053
  • 17 Driscoll DJ, Mottram CD, Danielson GK. Spectrum of exercise intolerance in 45 patients with Ebstein's anomaly and observations on exercise tolerance in 11 patients after surgical repair. J Am Coll Cardiol 1988; 11 (04) 831-836
  • 18 Attenhofer Jost CH, Connolly HM, Scott CG, Burkhart HM, Ammash NM, Dearani JA. Increased risk of possible paradoxical embolic events in adults with ebstein anomaly and severe tricuspid regurgitation. Congenit Heart Dis 2014; 9 (01) 30-37
  • 19 Roten L, Lukac P, DE Groot N. , et al. Catheter ablation of arrhythmias in ebstein's anomaly: a multicenter study. J Cardiovasc Electrophysiol 2011; 22 (12) 1391-1396
  • 20 Hebe J. Ebstein's anomaly in adults. Arrhythmias: diagnosis and therapeutic approach. Thorac Cardiovasc Surg 2000; 48 (04) 214-219
  • 21 Rossi L, Thiene G. Mild Ebstein's anomaly associated with supraventricular tachycardia and sudden death: clinicomorphologic features in 3 patients. Am J Cardiol 1984; 53 (02) 332-334
  • 22 Attie F, Rosas M, Rijlaarsdam M. , et al. The adult patient with Ebstein anomaly. Outcome in 72 unoperated patients. Medicine (Baltimore) 2000; 79 (01) 27-36
  • 23 Brown ML, Dearani JA, Danielson GK. , et al; Mayo Clinic Congenital Heart Center. The outcomes of operations for 539 patients with Ebstein anomaly. J Thorac Cardiovasc Surg 2008; 135 (05) 1120-1136 ; 1136.e1–1136.e7
  • 24 Badiu CC, Schreiber C, Hörer J. , et al. Early timing of surgical intervention in patients with Ebstein's anomaly predicts superior long-term outcome. Eur J Cardiothorac Surg 2010; 37 (01) 186-192
  • 25 Hetzer R, Hacke P, Javier M. , et al. The long-term impact of various techniques for tricuspid repair in Ebstein's anomaly. J Thorac Cardiovasc Surg 2015; 150 (05) 1212-1219
  • 26 Brown ML, Dearani JA, Danielson GK. , et al. Effect of operation for Ebstein anomaly on left ventricular function. Am J Cardiol 2008; 102 (12) 1724-1727
  • 27 Danielson GK, Maloney JD, Devloo RA. Surgical repair of Ebstein's anomaly. Mayo Clin Proc 1979; 54 (03) 185-192
  • 28 Carpentier A, Chauvaud S, Macé L. , et al. A new reconstructive operation for Ebstein's anomaly of the tricuspid valve. J Thorac Cardiovasc Surg 1988; 96 (01) 92-101
  • 29 da Silva JP, Baumgratz JF, da Fonseca L. , et al. The cone reconstruction of the tricuspid valve in Ebstein's anomaly. The operation: early and midterm results. J Thorac Cardiovasc Surg 2007; 133 (01) 215-223
  • 30 Dearani JA, Said SM, O'Leary PW, Burkhart HM, Barnes RD, Cetta F. Anatomic repair of Ebstein's malformation: lessons learned with cone reconstruction. Ann Thorac Surg 2013; 95 (01) 220-226 ; discussion 226–228
  • 31 Wu Q, Huang Z. Anatomic correction of Ebstein anomaly. J Thorac Cardiovasc Surg 2001; 122 (06) 1237-1238
  • 32 Wu Q, Huang Z. A new procedure for Ebstein's anomaly. Ann Thorac Surg 2004; 77 (02) 470-476 ; discussion 476
  • 33 Wu Q, Huang Z, Pan G, Wang L, Li L, Xue H. Early and midterm results in anatomic repair of Ebstein anomaly. J Thorac Cardiovasc Surg 2007; 134 (06) 1438-1440 ; discussion 1440–1442
  • 34 Hetzer R, Nagdyman N, Ewert P. , et al. A modified repair technique for tricuspid incompetence in Ebstein's anomaly. J Thorac Cardiovasc Surg 1998; 115 (04) 857-868
  • 35 Schmidt-Habelmann P, Meisner H, Struck E, Sebening F. Results of valvuloplasty for Ebstein's anomaly. Thorac Cardiovasc Surg 1981; 29 (03) 155-157
  • 36 Augustin N, Schmidt-Habelmann P, Wottke M, Meisner H, Sebening F. Results after surgical repair of Ebstein's anomaly. Ann Thorac Surg 1997; 63 (06) 1650-1656
  • 37 Komoda T, Komoda S, Nagdyman N, Berger F, Hetzer R. Combination of a Hetzer operation and a Sebening stitch for Ebstein's anomaly. Gen Thorac Cardiovasc Surg 2007; 55 (09) 355-359
  • 38 Ullmann MV, Born S, Sebening C, Gorenflo M, Ulmer HE, Hagl S. Ventricularization of the atrialized chamber: a concept of Ebstein's anomaly repair. Ann Thorac Surg 2004; 78 (03) 918-924 ; discussion 924–925
  • 39 Raj Behl P, Blesovsky A. Ebstein's anomaly: sixteen years' experience with valve replacement without plication of the right ventricle. Thorax 1984; 39 (01) 8-13
  • 40 Timmis HH, Hardy JD, Watson DG. The surgical management of Ebstein's anomaly. The combined use of tricuspid valve replacement, atrioventricular plication, and atrioplasty. J Thorac Cardiovasc Surg 1967; 53 (03) 385-391
  • 41 Warnes CA, Williams RG, Bashore TM. , et al; ACC/AHA 2008 guidelines for the management of adults with congenital heart disease. J Am Coll Cardiol 2008; 52 (23) e143-e263
  • 42 Baumgartner H, Bonhoeffer P, De Groot NMS. , et al; Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of Cardiology (ESC); Association for European Paediatric Cardiology (AEPC); ESC Committee for Practice Guidelines (CPG). ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 2010; 31 (23) 2915-2957
  • 43 Lillehei CW, Kalke BR, Carlson RG. Evolution of corrective surgery for Ebstein's anomaly. Circulation 1967; 35 (4, Suppl) I111-I118
  • 44 Chauvaud SM, Brancaccio G, Carpentier AF. Cardiac arrhythmia in patients undergoing surgical repair of Ebstein's anomaly. Ann Thorac Surg 2001; 71 (05) 1547-1552
  • 45 Oh JK, Holmes Jr DR, Hayes DL, Porter CBJ, Danielson GK. Cardiac arrhythmias in patients with surgical repair of Ebstein's anomaly. J Am Coll Cardiol 1985; 6 (06) 1351-1357
  • 46 Huang CJ, Chiu IS, Lin FY. , et al. Role of electrophysiological studies and arrhythmia intervention in repairing Ebstein's anomaly. Thorac Cardiovasc Surg 2000; 48 (06) 347-350
  • 47 Cobb FR, Blumenschein SD, Sealy WC, Boineau JP, Wagner GS, Wallace AG. Successful surgical interruption of the bundle of Kent in a patient with Wolff-Parkinson-White syndrome. Circulation 1968; 38 (06) 1018-1029
  • 48 Bockeria L, Golukhova E, Dadasheva M. , et al. Advantages and disadvantages of one-stage and two-stage surgery for arrhythmias and Ebstein's anomaly. Eur J Cardiothorac Surg 2005; 28 (04) 536-540
  • 49 Cox JL. Cardiac surgery for arrhythmias. Pacing Clin Electrophysiol 2004; 27 (02) 266-282
  • 50 Stulak JM, Dearani JA, Puga FJ, Zehr KJ, Schaff HV, Danielson GK. Right-sided maze procedure for atrial tachyarrhythmias in congenital heart disease. Ann Thorac Surg 2006; 81 (05) 1780-1784 ; discussion 1784–1785
  • 51 Liu J, Qiu L, Zhu Z, Chen H, Hong H. Cone reconstruction of the tricuspid valve in Ebstein anomaly with or without one and a half ventricle repair. J Thorac Cardiovasc Surg 2011; 141 (05) 1178-1183
  • 52 Chauvaud S, Fuzellier JF, Berrebi A. , 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 (05) 514-519
  • 53 Dearani JA. Editorial comment: lessons learned with tricuspid valve replacement. Eur J Cardiothorac Surg 2014; 45 (01) 90-91
  • 54 Brown ML, Dearani JA, Danielson GK. , et al. Comparison of the outcome of porcine bioprosthetic versus mechanical prosthetic replacement of the tricuspid valve in the Ebstein anomaly. Am J Cardiol 2009; 103 (04) 555-561
  • 55 Bartlett HL, Atkins DL, Burns TL. , et al. Early outcomes of tricuspid valve replacement in young children. Circulation 2007; 115 (03) 319-325
  • 56 Burri M, Vogt MO, Hörer J. , et al. Durability of bioprostheses for the tricuspid valve in patients with congenital heart disease. Eur J Cardiothorac Surg 2016; 50 (05) 988-993
  • 57 Chauvaud 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 (04) 525-531
  • 58 Ibrahim M, Tsang VT, Caruana M. , et al. Cone reconstruction for Ebstein's anomaly: Patient outcomes, biventricular function, and cardiopulmonary exercise capacity. J Thorac Cardiovasc Surg 2015; 149 (04) 1144-1150
  • 59 Vogel M, Marx GR, Tworetzky W. , et al. Ebstein's malformation of the tricuspid valve: short-term outcomes of the “cone procedure” versus conventional surgery. Congenit Heart Dis 2012; 7 (01) 50-58
  • 60 Liu X, Zhang Q, Yang ZG. , et al. Morphologic and functional abnormalities in patients with Ebstein's anomaly with cardiac magnetic resonance imaging: correlation with tricuspid regurgitation. Eur J Radiol 2016; 85 (09) 1601-1606
  • 61 Celermajer DS, Cullen S, Sullivan ID, Spiegelhalter DJ, Wyse RK, Deanfield JE. Outcome in neonates with Ebstein's anomaly. J Am Coll Cardiol 1992; 19 (05) 1041-1046
  • 62 Starnes VA, Pitlick PT, Bernstein D, Griffin ML, Choy M, Shumway NE. Ebstein's anomaly appearing in the neonate. A new surgical approach. J Thorac Cardiovasc Surg 1991; 101 (06) 1082-1087
  • 63 Reemtsen BL, Fagan BT, Wells WJ, Starnes VA. Current surgical therapy for Ebstein anomaly in neonates. J Thorac Cardiovasc Surg 2006; 132 (06) 1285-1290
  • 64 Reemtsen BL, Polimenakos AC, Fagan BT, Wells WJ, Starnes VA. Fate of the right ventricle after fenestrated right ventricular exclusion for severe neonatal Ebstein anomaly. J Thorac Cardiovasc Surg 2007; 134 (06) 1406-1410 ; discussion 1410–1412
  • 65 Knott-Craig CJ, Overholt ED, Ward KE, Razook JD. Neonatal repair of Ebstein's anomaly: indications, surgical technique, and medium-term follow-up. Ann Thorac Surg 2000; 69 (05) 1505-1510
  • 66 Knott-Craig CJ, Goldberg SP, Overholt ED, Colvin EV, Kirklin JK. Repair of neonates and young infants with Ebstein's anomaly and related disorders. Ann Thorac Surg 2007; 84 (02) 587-592 ; discussion 592–593
  • 67 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 (05) 1163-1169