Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute, Mirpur, Dhaka-1216, Bangladesh.
Department of Cardiac Surgery, Square Hospitals Limited, West, Panthapath, Dhaka-1205, Bangladesh.
Heart Surg Forum. 2022 Jan 17;25(1):E030-E036. doi: 10.1532/hsf.4165.
Cone repair of the tricuspid valve (TV) is a contemporary reproducible technique for surgical reconstruction of Ebstein's anomaly. Different authorities have shown that this technique restores excellent tricuspid valve function. In Bangladesh, this technique still is unfamiliar to many. We hereby present a case series of cone repair and TV replacement with the mid-term outcome (one year to six years) at the National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh.
We prospectively studied 21 patients, who underwent surgical intervention (cone repair or tricuspid valve replacement) for Ebstein's anomaly of TV from March 2014 to June 2020. We divided the total patient population into the cone repair and TV replacement groups. Preoperative, postoperative, and follow-up data were collected from the hospital records, telephone conversations, and clinic visits. All collected data statistically were analyzed.
Our patients showed there were statistically significant improvements after surgical intervention with regard to tricuspid regurgitation (TR) (P < 0.001), tricuspid annular plane systolic excursion (TAPSE) (P < 0.001), right ventricular (RV) function (P < 0.001), and New York Heart Association (NYHA) class (P < 0.001). These developments were sustained throughout the follow-up period.
Cone repair should be offered to the symptomatic patients of Ebstein's anomaly because symptoms relief, reduction of morbidity, and survival benefits are excellent. Above all, the cone reconstruction shows fantastic results and may well become the surgical technique for patients with Ebstein's anomaly. We hope that new valve repair programs may provide extended longevity and restored quality of life to the patient of Ebstein's anomaly (EA) with the appropriate measures. In case of failed repair, valve replacement is an encouraging option.
三尖瓣瓣环成形术（TV）是外科修复埃布斯坦畸形的一种现代可重复技术。不同的权威机构已经表明，该技术可以恢复极好的三尖瓣功能。在孟加拉国，这项技术对许多人来说仍然很陌生。我们在此介绍了 21 例在孟加拉国达卡国家心脏基金会医院和研究所接受三尖瓣成形术或置换术的埃布斯坦畸形患者的病例系列，随访时间为 1 年至 6 年。
我们前瞻性研究了 2014 年 3 月至 2020 年 6 月期间因 TV 埃布斯坦畸形接受手术干预（瓣环成形术或三尖瓣置换术）的 21 例患者。我们将总患者人群分为瓣环成形术和三尖瓣置换术组。从医院记录、电话交谈和门诊就诊中收集术前、术后和随访数据。所有收集的数据均进行了统计学分析。
我们的患者在接受手术干预后，三尖瓣反流（TR）（P<0.001）、三尖瓣环平面收缩期位移（TAPSE）（P<0.001）、右心室（RV）功能（P<0.001）和纽约心脏协会（NYHA）心功能分级（P<0.001）均有统计学显著改善。这些改善在整个随访期间都得到了维持。
对于有症状的埃布斯坦畸形患者，应提供瓣环成形术，因为症状缓解、降低发病率和生存获益都非常显著。最重要的是，瓣环重建术显示出了极好的结果，并且可能成为埃布斯坦畸形患者的手术技术。我们希望新的瓣膜修复方案可以通过适当的措施为埃布斯坦畸形患者提供更长的寿命和恢复生活质量。如果修复失败，瓣膜置换术是一个令人鼓舞的选择。
