Evaluation of tricuspid valve parameters after cone reconstruction in Ebstein’s anomaly

• Troshkinev N.M.
• Egunov O.A.
• Kozhanov R.S.
• Azarinova I.V.
• Shmakova N.A.
• Sokolov A.A.

Abstract

The operation of cone reconstruction of the tricuspid valve in Ebstein’s anomaly has been performed for the last 30 years since its appearance. The world literature describes the early and long-term results of world and national clinics. One of the actual questions remains what are the changes in the cone valve in children in the future after correction.

Aim. To analyze changes in the parameters of the tricuspid valve in patients with cone reconstruction in the early and long-term periods.

Material and methods. The study included 57 patients with cone reconstruction of the tricuspid valve. The echocardiographic parameters of the tricuspid valve were evaluated: the size of the fibrous ring in absolute dimensions and the indexed dimensions of the Z score index, peak and average gradient, as well as insufficiency on the valve after cone reconstruction. The average follow-up period was 66.5 [44; 82] months, the maximum follow-up period was 13 years.

Results. According to echocardiography data, in the long-term postoperative period, an increase in the fibrous ring of the tricuspid valve was observed, both in absolute values from 16.1 [12; 19] to 19.7 [16; 23] mm (p=0.002) and the Z score index from -1.3 [-1.9; -0.2] to -0.6 [-1.02; -0.2] (p=0.002). The pressure gradients on the valve after surgery were: peak 7.1 [5; 8] mmHg, mean 3.7 [3; 5] mmHg, and they did not change statistically in the long-term period: peak 7.45 [5; 9] mmHg, mean 3.63 [3; 5] mmHg (p=0.17) and (p=0.11), respectively. The insufficiency of the tricuspid valve after reconstruction was 44 (77.2%) in most patients up to mild, in 10 (17.5%) cases there was not insufficiency, and in 3 patients (5.3%) insufficiency was up to moderate. In the long–term period, the deficiency in tricuspid valve did not change statistically (p=0.146) and was equal to: no insufficiency -2 (6.1%), mild – 26 (78.7%), moderate – 5 (15.2%).

Conclusion. The results of our study show that after cone reconstruction, the fibrous ring of tricuspid valve grows in absolute and indexed values, and without increasing the peak and mean pressure gradients on the valve, as well as the degree of regurgitation. This circumstance allows us to say that cone reconstruction, as a method of valve reconstruction in Ebstein’s anomaly, is not only the most anatomical method of correction, but also the most physiological, optimal in childhood, when an important condition is the growth of the valve with the growth of the child.

Keywords: Ebstein’s anomaly; cone reconstruction; tricuspid valve

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