Abstract
Objective
In order to improve the function of the anterior leaflet as a monocusp valve in tricuspid valve repair for Ebstein's anomaly, a single-stitch technique after Sebening, creating a hinge point of the anterior leaflet on the ventricular septum on the opposite side, was newly incorporated into the Hetzer operation (either posterior annulorrhaphy or the double-orifice technique). We describe the operative technique of the modified operation and present the initial results.
Methods
Eleven patients who underwent the modified operation were involved in the study. Tricuspid valve function was assessed by echocardiography preoperatively and 3 months after the operation. Its improvement was studied, and compared with that after the conventional Hetzer operation (n = 15).
Results
After a mean follow-up period of 18.4 months (range 8.2–32.6 months), there were no early deaths and no cases of reoperation on the tricuspid valve in patients who had undergone the modified operation. At the last follow-up, 7 patients were in New York Heart Association class I, and 4 patients were in class II. The function of the tricuspid valve was significantly improved 3 months after the modified operation (P < 0.01, Wilcoxon signed-ranks test). Among the patients with Carpentier's classification type A or B, 85.7% of patients showed a tricuspid valve regurgitation (TR) grade of less than 2 after the modified operation, and this rate was significantly higher than that of 30.0% of patients in the group who underwent the conventional operation, (P < 0.05, Fisher's exact test).
Conclusion
The initial results of the new modification are satisfactory. However, a further follow-up and an accumulation of operative cases are necessary.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
P Schmidt-Habelmann H Meisner E Struck F Sebening (1981) ArticleTitleResults of valvuloplasty for Ebstein's anomaly Thorac Cardiovasc Surg 29 155–7 Occurrence Handle1:STN:280:DyaL3M3ltVWmtA%3D%3D Occurrence Handle10.1055/s-2007-1023466 Occurrence Handle6167013
R Hetzer N Nagdyman P Ewert YG Weng V Alexi-Meskhisvili F Berger et al. (1998) ArticleTitleA modified repair technique for tricuspid incompetence in Ebstein's anomaly J Thorac Cardiovasc Surg 115 857–68 Occurrence Handle1:STN:280:DyaK1c3jsFOmtw%3D%3D Occurrence Handle10.1016/S0022-5223(98)70367-8 Occurrence Handle9576222
CL Hancock Friesen R Chen JG Howlett DB Ross (2004) ArticleTitlePosterior annular plication: tricuspid valve repair in Ebstein's anomaly Ann Thorac Surg 77 2167–71 Occurrence Handle10.1016/j.athoracsur.2003.11.025 Occurrence Handle15172289
MV Ullmann S Born C Sebening M Gorenflo HE Ulmer S Hagl (2004) ArticleTitleVentricularization of the atrialized chamber: a concept of Ebstein's anomaly repair Ann Thorac Surg 78 918–25 Occurrence Handle10.1016/j.athoracsur.2004.02.134 Occurrence Handle15337020
KL Hardy IA May CA Webster KG Kimball (1964) ArticleTitleEbstein's anomaly: a functional concept and successful definitive repair J Thorac Cardiovasc Surg 48 927–40 Occurrence Handle1:STN:280:DyaF2M%2FksVCjsw%3D%3D Occurrence Handle14239982
GK Danielson JD Maloney RA Devloo (1979) ArticleTitleSurgical repair of Ebstein's anomaly Mayo Clin Proc 54 185–92 Occurrence Handle1:STN:280:DyaE1M7lsFemtg%3D%3D Occurrence Handle431125
A Carpentier S Chauvaud L Mace J Relland S Mihaileanu JP Marino et al. (1988) ArticleTitleA new reconstructive operation for Ebstein's anomaly of the tricuspid valve J Thorac Cardiovasc Surg 96 92–101 Occurrence Handle1:STN:280:DyaL1c3mtVejsA%3D%3D Occurrence Handle3386297
JM Quaegebeur N Sreeram AG Fraser AJ Bogers OF Stumper J Hess et al. (1991) ArticleTitleSurgery for Ebstein's anomaly: the clinical and echocardiographic evaluation of a new technique J Am Coll Cardiol 17 722–8 Occurrence Handle1:STN:280:DyaK3M7jtF2isw%3D%3D Occurrence Handle10.1016/S0735-1097(10)80190-1 Occurrence Handle1993793
Q Wu Z Huang (2004) ArticleTitleA new procedure for Ebstein's anomaly Ann Thorac Surg 77 470–6 Occurrence Handle10.1016/S0003-4975(03)01492-9 Occurrence Handle14759419
C Schreiber A Cook SY Ho N Augustin RH Anderson (1999) ArticleTitleMorphologic spectrum of Ebstein's malformation: revisitation relative to surgical repair J Thorac Cardiovasc Surg 117 148–55 Occurrence Handle1:STN:280:DyaK1M7gt1Gguw%3D%3D Occurrence Handle10.1016/S0022-5223(99)70480-0 Occurrence Handle9869769
N Nagdyman R Hetzer P Ewert T Komoda F Berger (2005) ArticleTitleEbstein's anomaly: long-term results after modified reconstruction of tricuspid valve without ventricle plication Z Herz-Thorax-Gefäßchir 19 252–6 Occurrence Handle10.1007/s00398-005-0518-9
S Chauvaud A Berrebi N d'Attellis E Mousseaux A Hernigou A Carpentier (2003) ArticleTitleEbstein's anomaly: repair based on functional analysis Eur J Cardiothorac Surg 23 525–31 Occurrence Handle1:STN:280:DC%2BD3s7ns1Gjsg%3D%3D Occurrence Handle10.1016/S1010-7940(02)00836-9 Occurrence Handle12694771
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Komoda, T., Komoda, S., Nagdyman, N. et al. Combination of a Hetzer operation and a Sebening stitch for Ebstein's anomaly. Gen Thorac Cardiovasc Surg 55, 355–359 (2007). https://doi.org/10.1007/s11748-007-0146-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-007-0146-2