• Eur J Cardiothorac Surg · Aug 2015

    Da Silva's cone repair for Ebstein's anomaly: effect on right ventricular size and function.

    • Rüdiger Lange, Melchior Burri, Lena Katharina Eschenbach, Catalin Constantin Badiu, José Pedro da Silva, Nicole Nagdyman, Sohrab Fratz, Jürgen Hörer, Andreas Kühn, Christian Schreiber, and Manfred Otto Vogt.
    • Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany DZHK (German Center for Cardiovascular Research)-partner site Munich Heart Alliance, Munich, Germany lange@dhm.mhn.de.
    • Eur J Cardiothorac Surg. 2015 Aug 1; 48 (2): 316-20; discussion 320-1.

    ObjectivesDa Silva's cone repair is a novel technique for surgical reconstruction of the tricuspid valve and the right ventricle (RV) in Ebstein's anomaly. The technique consists of extensive leaflet mobilization, longitudinal plication of the atrialized ventricle and cone-shaped reconstruction of the tricuspid valve, allowing for leaflet-to-leaflet coaptation. We evaluated the influence of Da Silva's cone repair on tricuspid competency, right ventricular size and function.MethodsFrom February 2010 until July 2013, 20 patients (median age 30.0 years, range 6.6-68.3 years) underwent Da Silva's cone repair. A 4- to 6-mm interatrial communication was left in all patients. Echocardiographic studies and magnetic resonance imaging (MRI) before and after the repair were evaluated.ResultsMedian follow-up was 11 (0.5-36) months. There were 2 early deaths and no late death. Echocardiography at follow-up revealed mild or absent tricuspid regurgitation in 16 patients. Two patients showed moderate tricuspid insufficiency. MRI studies showed that the mean functional RV end-diastolic volume decreased after surgery (pre 334 [135-656] ml; post 175 [115-404] ml, P < 0.001). The mean RV ejection fraction decreased (pre 47 ± 10%; post 35 ± 13%, P = 0.001), and the mean antegrade net stroke volume of the RV increased (pre 65 ± 28 ml; post 75 ± 30 ml, P = 0.057).ConclusionsDa Silva's cone repair for Ebstein's anomaly creates excellent valve function in all patients. Consecutively, the size of the RV decreases and the antegrade net stroke volume increases 6 months after the operation.© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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