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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 1195-1202, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
GK Danielson, DJ Driscoll, DD Mair, CA Warnes and WC Oliver Jr
From April 1972 to February 12, 1991, 189 patients with Ebstein's anomaly
underwent repair. Ages ranged from 11 months to 64 years (median 16 years,
mean 19.1 years). In 58.2%, tricuspid valve reconstruction was possible,
and in 36.5%, a prosthetic valve, usually a bioprosthesis, was inserted. In
5.3%, a modified Fontan or other procedure was performed. There were 12
hospital deaths (6.3%). All 28 patients who had accessory conduction
pathways (Wolff-Parkinson-White syndrome) underwent successful ablation of
the pathways as part of the operative treatment. Follow-up was obtained in
151 (85.3%) patients. Of those patients followed up more than 1 year after
operation, 92.9% were in New York Heart Association class I or II. There
were 10 late deaths: seven cardiac (four sudden), two noncardiac, and one
of an unknown cause. Postoperative Doppler echocardiographic assessment
showed the atrial septum was intact in all patients and tricuspid valve
function was good to excellent in most patients. Four of the 110 patients
(3.6%) who underwent valve reconstruction required reoperation 1.4 to 14.1
years later. Postoperative reduction in heart size was usual, atrial
arrhythmias were reduced, and late postoperative exercise testing showed a
significant improvement in performance: Maximal oxygen consumption
increased from a mean of 47% of predicted value before the operation to a
mean of 72% after the operation. Nine patients had a total of 12 successful
pregnancies with deliveries of normal children.
ARTICLES
Operative treatment of Ebstein's anomaly
Department of Surgery, Mayo Medical School, Mayo Foundation, Rochester, Minn. 55905.
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