Ann Thorac Surg 2005;79:1826-1827
© 2005 The Society of Thoracic Surgeons
Correspondence
Repair of Ebstein's Anomaly
Sylvain Marc Chauvaud, MD
Department of Cardiovascular Surgery, Hôpital Européan Georges Pompidou, 20, Rue Leblanc, 75015 Paris, France
(E-mail: sylvain.chauvaud{at}egp.ap-hop-paris.fr).
To the Editor:
I read with great interest the report by Drs Wu and Huang [1] on their procedure for Ebstein's anomaly. The incorporation of the abnormal septal and posterior leaflets in the repair is ingenious and innovative.
The description of the lesion in 1 patient in whom the diagnosis was confirmed at operation was as follows: "Half of the septal leaflet near to the antero-septal commissure was severely hypoplastic, which made this area to be absent from valve tissue. The remainder of the septal leaflet was displaced 1.5 cm from the annulus." On the basis of our experience, which is shared by others, my colleagues and I [2] find the anatomy to be different: the surface area of the septal leaflet is severely reduced with short chordae or a linear attachment to the septum. The displacement is minimal near the anteroseptal commissure and maximal where the posteroseptal commissure is supposed to be situated. The displacement is between 3 and 7 cm, and the leaflet tissue reaches the apex of the right ventricle in severe cases. The posterior leaflet is absent or severely reduced in 40% of our patients. In such situations, mobilization of the septal leaflet appears an impossible challenge. The leaflet extension technique could probably be useful, but the durability of fresh nonpreserved autologous pericardium needs to be confirmed.
In 1980, Carpentier and colleagues [2], demonstrated that the anterior leaflet has restricted motion, which is a major factor in tricuspid incompetence [3]. In our practice, the reduced motion of the anterior leaflet has to be treated to obtain a competent tricuspid valve. I would be interested to know how the authors solve the problem of reduced mobility of the anterior leaflet.
The right ventricular wall resection is a major contribution. It appears to be safe and to produce excellent results.
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References
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- Wu Q, Huang Z. A new procedure for Ebstein's anomaly Ann Thorac Surg 2004;77:470-476.[Abstract/Free Full Text]
- Carpentier A, Chauvaud S, Mace L, et al. A new reconstructive operation for Ebstein's anomaly of the tricuspid valve J Thorac Cardiovasc Surg 1988;96:92-101.[Abstract]
- Chauvaud S, Berrebi A, d'Attellis N, Mousseaux E, Hernigou A, Carpentier A. Ebstein's anomaly: repair based on functional analysis Eur J Cardio-thorac Surg 2003;23:525-531.[Abstract/Free Full Text]
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