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Ann Thorac Surg 2006;81:1443-1449
© 2006 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Ventricular Volumes in Ebstein's Anomaly: X-Ray Multislice Computed Tomography Before and After Repair

^a Department of Cardiovascular Surgery, Georges Pompidou European Hospital, Paris, France
^b Department of Radiology, Georges Pompidou European Hospital, Paris, France
^c Department of Pediatric Cardiology, Necker Hospital, Paris, France
^d Department of Physiology, Le Kremlin-Bicêtre Hospital, Le Kremlin-Bicêtre Cedex, France

Accepted for publication October 4, 2005.

^_* Address correspondence to Dr Chauvaud, Department of Cardiovascular Surgery, Georges Pompidou European Hospital, 20 rue Leblanc, 75015 Paris, France (Email: sylvain.chauvaud{at}egp.ap-hop-paris.fr).

BACKGROUND: This study was performed to measure right and left ventricular volumes in Ebstein's anomaly before and after operation.

METHODS: Twenty-six consecutive patients were operated on with tricuspid valve repair and plication of the atrialized right ventricle, associated with a bidirectional cavopulmonary shunt in 15 patients. Right ventricular (RV) and left ventricular end-diastolic and end-systolic volume indexes were measured by x-ray computerized tomography before and after surgical repair. Left ventricular stroke index and ejection fraction were calculated.

RESULTS: Before surgery, the mean stroke index of the atrialized RV was 36 ± 33 mL/m², with severe reduction in 9 patients and aneurysmal aspect in 2 patients. After surgery, the atrialized RV was no longer identifiable. Both RV end-diastolic volume index and stroke index of the remaining effective RV were reduced. Bidirectional cavopulmonary shunt was a determinant factor of decrease in the effective RV end-diastolic volume index after repair. Conversely, left ventricular ejection fraction and stroke index increased significantly after surgery.

CONCLUSIONS: The atrialized RV with dyskinesia seems a good indication for a plication. RV end-diastolic volume index of the effective RV decreased after surgery. In severe cases, bidirectional cavopulmonary shunt was useful by decreasing RV end-diastolic volume, thus preventing further RV dilation. In all cases left ventricular ejection fraction and stroke volume index increased after surgery.

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