Ebsteins anomaly of the tricuspid valve surgery
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Ebsteins anomaly of the tricuspid valve Microchapters | |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] and Claudia P. Hochberg, M.D. [2] Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]
Overview
Tricuspid valve repair is indicated in patients in which there is symptoms or deteriorating exercise capacity, cyanosis (oxygen saturation less than 90%), paradoxical embolism, progressive cardiomegaly on chest x-ray or progressive right ventricular dilation or reduction of right ventricular systolic function. When possible, repair is favored over replacement.
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease (DO NOT EDIT)[1][2]
Surgical Interventions (DO NOT EDIT)[1][2]
| Class I |
| "1. Surgeons with training and expertise in CHD should perform tricuspid valve repair or replacement with concomitant closure of an ASD, when present, for patients with Ebstein’s anomaly with the following indications: |
| a. Symptoms or deteriorating exercise capacity. (Level of Evidence: B) |
| b. Cyanosis (oxygen saturation less than 90%). (Level of Evidence: B) |
| c. Paradoxical embolism. (Level of Evidence: B) |
| d. Progressive cardiomegaly on chest x-ray. (Level of Evidence: B) |
| e. Progressive RV dilation or reduction of RV systolic function. (Level of Evidence: B)" |
| "2.Surgeons with training and expertise in CHD should perform concomitant arrhythmia surgery in patients with Ebstein’s anomaly and the following indications: |
| a. Appearance/progression of atrial and/or ventricular arrhythmias not amenable to percutaneous treatment. (Level of Evidence: B) |
| b. Ventricular preexcitation not successfully treated in the electrophysiology laboratory. (Level of Evidence: B)" |
| "3. Surgical rerepair or replacement of the tricuspid valve is recommended in adults with Ebstein’s anomaly with the following indications: |
| a. Symptoms, deteriorating exercise capacity, or New York Heart Association functional class III or IV. (Level of Evidence: B) |
| b. Severe TR after repair with progressive RV dilation, reduction of RV systolic function, or appearance/ progression of atrial and/or ventricular arrhythmias. (Level of Evidence: B) |
| c. Bioprosthetic tricuspid valve dysfunction with significant mixed regurgitation and stenosis. (Level of Evidence: B) |
| d. Predominant bioprosthetic valve stenosis (mean gradient greater than 12 to 15 mm Hg). (Level of Evidence: B) |
| e. Operation can be considered earlier with lesser degrees of bioprosthetic stenosis with symptoms or decreased exercise tolerance. (Level of Evidence: B)" |
Surgical Complications and Prognosis
Generally, surgical treatment improves the exercise intolerance from NYHA-FC III or IV to NYHA-FC I or II.
Hospital mortality at the Mayo for valve reconstruction is 6.7%. Only 1.6% in the Mayo series required reoperation. Long term follow up in the Mayo series showed 92% to have Class I or II symptoms and a 10 year mortality rate of 8%.
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References
- ↑ 1.0 1.1 Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease)". Circulation. 118 (23): 2395–451. doi:10.1161/CIRCULATIONAHA.108.190811. PMID 18997168.
- ↑ 2.0 2.1 Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.