194 * DA SILVA'S CONE REPAIR FOR EBSTEIN'S ANOMALY: EFFECT ON RIGHT VENTRICULAR SIZE AND FUNCTION

Abstract

Objectives: Da Silva's cone repair is a novel technique for surgical reconstruction of the tricuspid valve and the right ventricle in Ebstein's anomaly. The technique consists of extensive leaflet mobilisation, longitudinal plication of the atrialised 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 (RV) size and RV function. Methods: From 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 4–6-mm interatrial communication was left in all patients. Echocardiographic studies and magnetic resonance imaging (MRI) before and after the repair were evaluated. Results: Median follow-up was 11 (0.5–36) months. There were 2 early deaths and no late deaths. 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 327 ml; post 210 ml, P < 0.001). The mean RV ejection fraction decreased (pre 47%; post 35%, P = 0.001), and the mean antegrade net stroke volume of the RV increased (pre 65 ml; post 75 ml, P = 0.057). Conclusion: Da 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.