Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Germany.
J Thorac Cardiovasc Surg. 2011 May;141(5):1192-5. doi: 10.1016/j.jtcvs.2010.08.083. Epub 2010 Nov 19.
The purpose of this longitudinal study was to assess improvements in exercise performance and quality of life in patients with Ebstein anomaly after surgical intervention.
In 21 patients with Ebstein anomaly (between 6 and 59 years of age; 16 female, 5 male) who underwent surgery for tricuspid regurgitation and, if present, closure of an interatrial shunt, a cardiopulmonary exercise test and a quality-of-life assessment by the Medical Outcomes Study 36 item short form was performed prior to and 6 to 18 months after surgery.
After surgery, peak oxygen uptake increased from 68.4% of predicted to 77.3% of predicted (P = .009), and ventilatory efficiency (VE/VCO(2) slope) improved from 32.5 to 29.3 (P = .001). In 14 patients with additional interatrial shunt closure, oxygen saturation improved from 95% to 99% at rest (P = .003) and from 88% to 99% under peak exercise (P = .003). Improvements in VE/VCO(2) slope were similar in patients who had undergone primary surgery (P = .005) or reoperation (P = .018). Increase in exercise capacity was also similar in both groups but failed significance in both (primary surgery, P = .064; reoperation, P = .063). There was no difference between tricuspid valve repair and replacement in the short-term follow-up. Self-estimated quality of life was fairly good prior to and after surgery. Only in the single question about health transition at follow-up did the patients confirm an improved situation after surgery.
Patients with Ebstein anomaly and severe tricuspid regurgitation draw clinical benefit from surgical intervention as measured on exercise testing. This holds true for primary surgery and for reoperation.
本纵向研究旨在评估手术干预后埃布斯坦畸形患者运动表现和生活质量的改善情况。
在 21 例埃布斯坦畸形（年龄 6 至 59 岁；女性 16 例，男性 5 例）患者中，行三尖瓣反流手术，如存在房间隔分流则行封堵术。术前及术后 6 至 18 个月行心肺运动试验和健康调查简表 36 项条目评估生活质量。
术后，峰值摄氧量从预测值的 68.4%增加至 77.3%（P =.009），通气效率（VE/VCO2斜率）从 32.5 改善至 29.3（P =.001）。在 14 例行房间隔分流封堵术的患者中，静息时氧饱和度从 95%改善至 99%（P =.003），运动峰值时从 88%改善至 99%（P =.003）。行初次手术（P =.005）或再次手术（P =.018）患者的 VE/VCO2斜率改善情况相似。两组运动能力的增加也相似，但均未达到统计学意义（初次手术，P =.064；再次手术，P =.063）。短期随访中三尖瓣修复与置换无差异。手术前后患者自我评估生活质量均较好。仅在随访时健康状况转变单项问题中，患者确认术后情况改善。
严重三尖瓣反流的埃布斯坦畸形患者可从手术干预中获益，运动试验可评估获益情况。初次手术和再次手术均有效。
