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Surgical treatment of Ebstein's malformation—the ‘Hôpital Broussais’ experience

Published online by Cambridge University Press:  19 August 2008

Sylvain M. Chauvaud ,
Serban A. Mihaileanu ,
Julian A.R. Gaer  and
Alain C. Carpentier
Sylvain M. Chauvaud*
Affiliation:
From the Department of Cardiovascular Surgery, Hôpital Broussais, Paris
Serban A. Mihaileanu
Affiliation:
From the Department of Cardiovascular Surgery, Hôpital Broussais, Paris
Julian A.R. Gaer
Affiliation:
From the Department of Cardiovascular Surgery, Hôpital Broussais, Paris
Alain C. Carpentier
Affiliation:
From the Department of Cardiovascular Surgery, Hôpital Broussais, Paris
*
Dr. Sylvain M. Chauvaud, Hôpital Broussais, Service de Chirurgie Cardiovasculaire, 96 rue Didot, 75014 Paris, France. Tel. 33 1 43 95 93 46; Fax. 33 1 43 95 93 42.
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Abstract

Ebstein's malformation is usually treated by replacing the tricuspid valve, albeit with controversial results. The “Carpentier technique,” introduced in 1980, offers both a new classification and new surgical methods for treatment of this lesion. The classification is based on the severity of the displacement of the septal and posteroinferior leaflets, with four grades of increasing severity. The surgical techniques involve mobilization of the anterosuperior leaflet, reduction of the diameter of the annulus, and longitudinal plication of the atrialized part of the right ventricle. Following this approach, 64 patients underwent consecutive surgical evaluation, with only one valvar replacement. The mean age was 26±15 years. The hospital mortality was nine percent. The mean follow-up is now 5.18±3.25 years. The actuarial survival rate was 87% at one year and 82% at five and 10 years. Of the patients, 90% were in postoperative functional class I or II. Control echocardiography revealed either no insufficiency, or minimal regurgitation in 80%. A second operation was needed in six patients because of right ventricular failure (two patients) or recurrence of valvar insufficiency (four patients). Sinus rhythm was present in 44 (88%) of the surviving patients. We conclude that repair of the malformed tricuspid valve, associated with longitudinal plication of the right ventricle, is safe and efficient. The prognosis depends on right ventricular contractility, which should be evaluated carefully before and after the operative procedure.

Keywords

Ebstein's malformationconservative valvar surgerytricuspid valvar insufficiency
Type
Original Manuscripts
Information
Cardiology in the Young , Volume 6 , Issue 1 , January 1996 , pp. 4 - 11
Copyright
Copyright © Cambridge University Press 1996

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