The Clinical Research Of Surgical Theatment Of Ebstein Anomaly

Objective To Summarized 26 cases of congenital Ebstein,s anomaly surgery exper- -ience in order to explore the method and outcome of rebuiding postier leaflet with autologous pericardium in the valvuloplasty for Ebstein,s anomaly.Methods Retrospective analysis of our hospital from January 2002 to August 2008 between the treated patients with Ebstein,s anomaly of the clinical data,26 patients with Ebstein,s anomaly who showed moderate to severe reflux of tricuspid valve and postier leaflet dysplasia in echocardiography belonging to typeⅡandⅢof carpentier subtypes underwent the rebuilding of hypoplastic leaflet with autologous pericardium,placation of the atrialized ventricular wall,tricuspid annuloplasty, and the merger deal with other malformations in the same period.During surgery,the pericardial edge was layed on tricuspid valve ring,the Double Needles which placated the atrialized ventricular wall in rampage passed through it directly and pushed it down and ligated on the ring with little mats.The autologous pericardium was cut into rectangle,one diagonal edge which was trimde a little sutured on right ventricular septal surface and formed reconstruction tendons. The coronary sinus were placed in the right ventricle with autologous pericardium in placation,such can protect atrioventricular node. 19 cases of typeⅡwere employed the rebuilding of hypoplastic leaflet with autologous pericardium and placation of the atrialized ventricular wall; For its functional right ventricule reduced significantly and right heart function decreased apprenly, Glenn surgery were added including rebuilding and placation in 7 cases of typeⅢ.the merger deal with other malformations in the same period.Those data such as cardiothoracic ratio,right ventricular internal dimension,tricuspid insufficiency degree and cardiac function were collected from chest X-ray and echocardiography by postoperative follow-up,and these data were analyzed comperetively between postoperative and preoperative condition.Results Postoperative mortality was 0. Follow-up of 6 months~71 months, follow-up rate of 100%. After reviewing the entire chest X-ray showed cardiothoracic ratio decreased significantly (0.56±0.04Vs0.62±0.04,p<0.01); reviewing echocardiography right ventricular internal dimension reduced significantly [(26.6±4.1Vs42.1±5.8)mm,p<0.01], tricuspid insufficiency degree improved significantly, and no tricuspid valve stenosis or autologous pericardium calcification signs was found. Postoperative cardiac function (NHYA classification) improved significantly than preoperative.The complication of right bundle brunch blocking occurred in 2 cases.Conclusion Rebuiding postier leaflet with autologous pericardium in the valvuloplasty for Ebstein,s anomaly can bing satisfactory results in the short-term and mid-term.