Öz
Aim: Ebstein
anomaly is a rare congenital cardiac disorder that causing by failure of
delamination of the tricuspid valve. Various surgical methods have been
developed so far as treatment options. Our initial experience and short term
follow up reported herein.
Materials and Methods: Ten patients underwent surgical treatment with a diagnosis of
Ebstein anomaly in our center between 2007 and 2017. Two patients underwent one
and a half ventricle repair and Danielson method applied to eight patients. The
X-clamping and cardiopulmonary by-pass (CPB) timing, duration in intensive care
unit (ICU), extubation time and need for blood product were compared between
Danielson and one and a half ventricle repair applied patients.
Results: There
was no mortality among patients. In the one and a half repair applied group
both X-clamping (p=0.044) and CPB time (p=0.044) was longer compared to
Danielson group. On the other hand there is no significantly difference between
groups in ICU duration (p=0.400) or extubation timing (p=0.889). Furthermore,
need for blood product and amount of drainage were not different between groups
when two infant age cases were excepted while calculating.
Conclusion: Danielson method is safe and effective in the repair of Ebstein anomaly
and can be applied at infant age with similar clinical outcomes. Nevertheless,
one and a half repair option is also beneficial in patients with a large size
atrialized right ventricular volume. The last decision should be confirmed by
heart team considering patient characteristics and surgeons’ past experience.
Anahtar Kelimeler
Ebstein anomaly Danielson method one and a half ventricle repair.
Kaynakça
- Schiebler GL, Gravenstein JS, Van Mierop LH. Ebstein's anomaly of the tricuspid valve: Translation of original description with comments. Am J Cardiol 1968;22(6): 867-73.
- Danielson GK. Ebstein’s anomaly: Editorial comments and personal observations. Ann Thorac Surg 1982;34(4),396-400.
- Porter JC. Ebstein's anomaly of the tricuspid valve. In: Garson A, Bricker JT, eds. The science and practice of pediatric cardiology. Philadelphia: Lea and Febiger Publ 1990:1134-44.
- 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(1):92-101.
- Dearani JA, Danielson GK. Congenital heart surgery nomenclature and database project: Ebstein's anomaly and tricuspid valve disease. Ann Thorac Surg 2000;69(3):106-17.
- Frescura C, Angelini A, Daliento L, et al. Morphological aspects of Ebstein's anomaly in adults. J Thorac Cardiovasc Surg 2000;48(04):203-8.
- Malvindi PG, Viola N. Ebstein's anomaly: Diagnosis and surgical treatment. G Ital Cardiol 2015;16(3):175-85.
- Brown ML, Dearani JA, Danielson GK, et al. The outcomes of operations for 539 patients with Ebstein anomaly. J Thorac Cardiovasc Surg 2008;135(5):1120-36.
- Anderson HN, Dearani JA, Said SM, et al. Cone reconstruction in children with Ebstein anomaly: The Mayo Clinic experience. Congenit Heart Dis 2014;9(3):266-71.
- Silva JP, Silva L da F, Moreira LF, et al. Cone reconstruction in Ebstein’s anomaly repair: Early and long-term results. Arq Bras Cardiol 2011;97(3):199-208.
- Boston US, Goldberg SP, Ward KE, et al. Complete repair of Ebstein anomaly in neonates and young infants: A 16-year follow-up. J Thorac Cardiovasc Surg 2011;141(5):1163-9.
- Allen MR, Hayes DL, Warnes CA, et al. Permanent pacing in Ebstein's anomaly. Pacing Clin Electrophysiol 1997;20(5):1243-6.
- Brown ML, Dearani JA, Danielson G, et al. Effect of operation for Ebstein anomaly on left ventricular function. Am J Cardiol 2008;102(12):1724-7.
- Takagaki M, Ishino K, Kawada M, et al. Total right ventricular exclusion improves left ventricular function in patients with end-stage congestive right ventricular failure. Circulation 2003;108(10):226-9.
- Saxena A, Lee AHS, Fong LV. Functional and histological abnormalities of the left ventricle in Ebstein’s anomaly of the tricuspid valve. Indian Heart J 1993;45(2):135-6.
- Quinonez LG, Dearani JA, Puga FJ, et al. Results of the 1.5-ventricle repair for Ebstein anomaly and the failing right ventricle. J Thorac Cardiovasc Surg 2007;133(5):1303-10.
Öz
Amaç: Ebstein anomalisi
triküspid kapak delaminasyonundaki yetersizlik sonucu oluşan nadir bir
konjenital kalp hastalığıdır. Hastalığın tedavisinde farklı cerrahi yöntemler
bugüne dek tanımlanmıştır. Bu çalışmada cerrahi deneyim ve kısa dönem cerrahi
sonuçlarımızı belirtmekteyiz.
Gereç ve Yöntem: Çalışmaya 2007-2017 yılları arasında merkezimizde Ebstein anomalisi
tanısı ile opere edilen on hasta dahil edildi. İki hastaya bir buçuk ventrikül
tamiri uygulanırken diğer sekiz hasta Danielson metodu ile opere edildi. Bu
hasta grupları arasında kros klemp ve kardiyopulmoner by-pass zamanları ile
yoğun bakım ve entübasyon süreleri ve kan ürünü replasman gereksinimleri
karşılaştırıldı.
Bulgular: Hastalarda mortalite gözlenmedi. Bir buçuk ventrikül tamiri uygulanan
hastalarda Danielson uygulanan hasta grubuna göre hem kros klemp (p=0,044) hem
de kardiyopulmoner by-pass süresi (p=0,044) daha az izlendi. Diğer yönden iki
grup arasında yoğun bakım yatış süreleri (p=0,400) veya entübasyon süreleri
(p=0,889) arasında anlamlı fark izlenmedi. Danielson ameliyatı uygulanan iki
infant hasta hesaplamaya dahil edilmediği durumda yapılan karşılaştırmada, kan
ürünü gereksinimi ve drenaj miktarlarında gruplar arasında belirgin fark
izlenmedi.
Sonuç: Danielson metodu, infant
yaş grubunda Ebstein anomalisi tedavisinde diğer tanımlanmış tamir yöntemlerine
benzer klinik sonuçlarla, güvenli ve etkin bir biçimde uygulanabilir. Yine de
bir buçuk ventrikül tamir seçeneği geniş atriyalize ventrikülü olan hastalarda
faydalı bir yöntemdir. Nihai karar hastanın karakteri ve cerrahi ekibin geçmiş
tecrübeleri göz önüne alınarak kalp ekibi tarafından verilmelidir.
Anahtar Kelimeler
Ebstein anomalisi Danielson metodu bir buçuk ventrikül onarımı.
Kaynakça
- Schiebler GL, Gravenstein JS, Van Mierop LH. Ebstein's anomaly of the tricuspid valve: Translation of original description with comments. Am J Cardiol 1968;22(6): 867-73.
- Danielson GK. Ebstein’s anomaly: Editorial comments and personal observations. Ann Thorac Surg 1982;34(4),396-400.
- Porter JC. Ebstein's anomaly of the tricuspid valve. In: Garson A, Bricker JT, eds. The science and practice of pediatric cardiology. Philadelphia: Lea and Febiger Publ 1990:1134-44.
- 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(1):92-101.
- Dearani JA, Danielson GK. Congenital heart surgery nomenclature and database project: Ebstein's anomaly and tricuspid valve disease. Ann Thorac Surg 2000;69(3):106-17.
- Frescura C, Angelini A, Daliento L, et al. Morphological aspects of Ebstein's anomaly in adults. J Thorac Cardiovasc Surg 2000;48(04):203-8.
- Malvindi PG, Viola N. Ebstein's anomaly: Diagnosis and surgical treatment. G Ital Cardiol 2015;16(3):175-85.
- Brown ML, Dearani JA, Danielson GK, et al. The outcomes of operations for 539 patients with Ebstein anomaly. J Thorac Cardiovasc Surg 2008;135(5):1120-36.
- Anderson HN, Dearani JA, Said SM, et al. Cone reconstruction in children with Ebstein anomaly: The Mayo Clinic experience. Congenit Heart Dis 2014;9(3):266-71.
- Silva JP, Silva L da F, Moreira LF, et al. Cone reconstruction in Ebstein’s anomaly repair: Early and long-term results. Arq Bras Cardiol 2011;97(3):199-208.
- Boston US, Goldberg SP, Ward KE, et al. Complete repair of Ebstein anomaly in neonates and young infants: A 16-year follow-up. J Thorac Cardiovasc Surg 2011;141(5):1163-9.
- Allen MR, Hayes DL, Warnes CA, et al. Permanent pacing in Ebstein's anomaly. Pacing Clin Electrophysiol 1997;20(5):1243-6.
- Brown ML, Dearani JA, Danielson G, et al. Effect of operation for Ebstein anomaly on left ventricular function. Am J Cardiol 2008;102(12):1724-7.
- Takagaki M, Ishino K, Kawada M, et al. Total right ventricular exclusion improves left ventricular function in patients with end-stage congestive right ventricular failure. Circulation 2003;108(10):226-9.
- Saxena A, Lee AHS, Fong LV. Functional and histological abnormalities of the left ventricle in Ebstein’s anomaly of the tricuspid valve. Indian Heart J 1993;45(2):135-6.
- Quinonez LG, Dearani JA, Puga FJ, et al. Results of the 1.5-ventricle repair for Ebstein anomaly and the failing right ventricle. J Thorac Cardiovasc Surg 2007;133(5):1303-10.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Haziran 2019 |
| Gönderilme Tarihi | 1 Mart 2018 |
| Yayımlandığı Sayı | Yıl 2019 |