Fakhri Dicky, Busro Pribadi Wiranda, Rahmat Budi, Purba Salomo, Prakoso Radityo, Turnip Chaisari Maria M, Taqwaariva Alyarosa
Department of Surgery, Pediatric and Congenital Heart Surgery Unit, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia.
Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia.
Ann Pediatr Cardiol. 2024 Jul-Aug;17(4):272-276. doi: 10.4103/apc.apc_134_24. Epub 2024 Nov 15.
Surgical intervention is the definitive treatment for Ebstein anomaly, offering both biventricular and nonbiventricular repair options. The objective of this study is to identify a specific cutoff value for tricuspid septal leaflet displacement, which will be a crucial factor in determining the selection of a surgical approach with lower mortality risk in biventricular repair.
This is a retrospective cohort study of consecutive patients with Ebstein anomaly undergoing surgical intervention at the National Cardiovascular Center Harapan Kita from January 2010 to December 2023. A total of 83 patients with Ebstein anomaly were treated surgically; 43 of those underwent biventricular repair, whereas the remaining underwent nonbiventricular repair. Echocardiography was performed, and the Great Ormond Street Echocardiography score was calculated. Several risk factors were identified and stratified for patients with biventricular repair ( = 43). Tricuspid septal leaflet displacement was measured for each patient, and there was a statistically significant higher mortality risk directly proportional to higher displacement in patients with biventricular repair ( < 0.05). A cutoff value of 43.5 mm/m² for the tricuspid septal leaflet displacement is the best predictor of mortality risk in biventricular repair with 83.3% sensitivity and 93.3% specificity.
In patients with Ebstein anomaly undergoing a biventricular repair, mortality rates are significantly elevated in patients with a higher tricuspid septal leaflet displacement distance. The results of the study indicated that the mortality risk in biventricular repair can be predicted based on the tricuspid septal leaflet displacement distance using a cutoff value of 43.5 mm/m².
手术干预是治疗埃布斯坦畸形的确定性疗法，提供双心室和非双心室修复选择。本研究的目的是确定三尖瓣隔叶移位的特定临界值，这将是决定双心室修复中选择死亡率风险较低的手术方法的关键因素。
这是一项回顾性队列研究，研究对象为2010年1月至2023年12月在哈帕恩·基塔国家心血管中心接受手术干预的连续性埃布斯坦畸形患者。共有83例埃布斯坦畸形患者接受了手术治疗；其中43例接受了双心室修复，其余患者接受了非双心室修复。进行了超声心动图检查，并计算了大奥蒙德街超声心动图评分。对接受双心室修复的患者（n = 43）识别并分层了几个风险因素。测量了每位患者的三尖瓣隔叶移位，在接受双心室修复的患者中，死亡率风险与移位增加直接成正比，具有统计学显著性（P < 0.05）。三尖瓣隔叶移位的临界值为43.5 mm/m²是双心室修复中死亡率风险的最佳预测指标，敏感性为83.3%，特异性为93.3%。
在接受双心室修复的埃布斯坦畸形患者中，三尖瓣隔叶移位距离较高的患者死亡率显著升高。研究结果表明，使用43.5 mm/m²的临界值，基于三尖瓣隔叶移位距离可以预测双心室修复中的死亡率风险。
