Repair of Ebstein anomaly and impaired right ventricular function pose challenges for the cardiac surgeon especially in adult patients. The bidirectional cavopulmonary shunt may improve early outcomes. We reviewed our experience with the 1.5-ventricle repair in this patient population. Materials and Methods: Between 2000 and 2011, 10 patients underwent 1.5 ventricle repair for Ebstein anomaly. All of them had a bidirectional cavopulmonary shunt constructed. Six of them were operated in Tirana, Albania. The median age at operation was 15 years (55 months-27.8 years). All of the patients had severe Ebstein anomaly with dilated right-sided chambers and/or right ventricular dysfunction. The mean left ventricular ejection fraction was 55% Results: Procedures included bidirectional cavopulmonary shunting (10), tricuspid valve replacement (1), tricuspid valve repair (9), and right ventricular plication according to Danielson 4 and according to Carpentier in 6 patients, ASD closure in 3. Shunting was planned preoperatively in 8 patients; the indication in 2 other patients was hemodynamic instability after separation from cardiopulmonary bypass. The azygos vein was left open in all patients on 11/2 repair to prevent severe postoperative central venous hypertension. One patient underwent Fontan operation 24 hours after the first procedure. This patient died during the second procedure due to low cardiac output. At follow-up, tricuspid incompetence of 8 survived patients with bidirectional cavopulmonary shunt undergoing tricuspid repair was mild in 6 and moderate in 2. One of the patient undergoing repair at 19 year old, became a mother 3 years later, with an excellent pregnancy period. Conclusions: The 1.5-ventricle repair in association with tricuspid valve repair can be employed with excellent outcome in patients with severe Ebstein anomaly and impaired right ventricular function who are at high risk for surgical treatment. We believe the bidirectional cavopulmonary shunt may be considered as a planned procedure, as an intraoperative salvage maneuver, or as an alternative to cardiac transplantation in selected patients.

Postoperative outcome in patients undergoing glenn operation in association with tricuspid valve repair for ebstein anomaly and failing right ventricle / Prifti E.; Baboci A.; Veshti A.; Kajo E.; Dado E.; Fagu A.; Bonacchi M.; Kuci S.; Vanini V.. - In: THE HEART SURGERY FORUM. - ISSN 1098-3511. - STAMPA. - (2012), pp. 339-340.

Postoperative outcome in patients undergoing glenn operation in association with tricuspid valve repair for ebstein anomaly and failing right ventricle

BONACCHI, MASSIMO;
2012

Abstract

Repair of Ebstein anomaly and impaired right ventricular function pose challenges for the cardiac surgeon especially in adult patients. The bidirectional cavopulmonary shunt may improve early outcomes. We reviewed our experience with the 1.5-ventricle repair in this patient population. Materials and Methods: Between 2000 and 2011, 10 patients underwent 1.5 ventricle repair for Ebstein anomaly. All of them had a bidirectional cavopulmonary shunt constructed. Six of them were operated in Tirana, Albania. The median age at operation was 15 years (55 months-27.8 years). All of the patients had severe Ebstein anomaly with dilated right-sided chambers and/or right ventricular dysfunction. The mean left ventricular ejection fraction was 55% Results: Procedures included bidirectional cavopulmonary shunting (10), tricuspid valve replacement (1), tricuspid valve repair (9), and right ventricular plication according to Danielson 4 and according to Carpentier in 6 patients, ASD closure in 3. Shunting was planned preoperatively in 8 patients; the indication in 2 other patients was hemodynamic instability after separation from cardiopulmonary bypass. The azygos vein was left open in all patients on 11/2 repair to prevent severe postoperative central venous hypertension. One patient underwent Fontan operation 24 hours after the first procedure. This patient died during the second procedure due to low cardiac output. At follow-up, tricuspid incompetence of 8 survived patients with bidirectional cavopulmonary shunt undergoing tricuspid repair was mild in 6 and moderate in 2. One of the patient undergoing repair at 19 year old, became a mother 3 years later, with an excellent pregnancy period. Conclusions: The 1.5-ventricle repair in association with tricuspid valve repair can be employed with excellent outcome in patients with severe Ebstein anomaly and impaired right ventricular function who are at high risk for surgical treatment. We believe the bidirectional cavopulmonary shunt may be considered as a planned procedure, as an intraoperative salvage maneuver, or as an alternative to cardiac transplantation in selected patients.
2012
339
340
Prifti E.; Baboci A.; Veshti A.; Kajo E.; Dado E.; Fagu A.; Bonacchi M.; Kuci S.; Vanini V.
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in FLORE sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/822191
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus ND
  • ???jsp.display-item.citation.isi??? ND
social impact