A MODIFIED REPAIR TECHNIQUE FOR TRICUSPID INCOMPETENCE IN EBSTEINS-ANOMALY

Objective: A modified technique for tricuspid valve repair in Ebstein' s anomaly restructures the valve mechanism at the level of the true tr icuspid anulus by using the most mobile leaflet for valve closure with out plication of the atrialized chamber. Midterm results of this thera peutic approach for patients with Ebstein's anomaly and tricuspid valv e incompetence are reported. Methods: Between October 1988 and April 1 997, the incompetent tricuspid valve was repaired with our technique i n 19 patients (12 female, 7 male; 2 to 54 years, mean 21 years). The i ndication for operation was congestive heart failure of various degree s in all patients. Tricuspid incompetence was grade II in two patients , grade III in 14, and grade IV in three. Associated congenital malfor mations were simultaneously repaired (interatrial communication in 18, ventricular septal defect in two, pulmonary stenosis in two, mitral v alve prolapse in one). Follow-up ranged between 10 and 103 months (med ian 28 months) and was complete for all patients. Results: There were no operative deaths, One patient with active endocarditis and pulmonar y abscess died 2 months after the operation of recurrent sepsis; there were no late deaths, During follow-up, New York Heart Association fun ctional class improved from 2.8 before the operation to 1.9 without re current cyanosis, and tricuspid incompetence decreased from a mean gra de of 3.1 to one of 0.9, without any echocardiographic deterioration o f the tricuspid valve function or right ventricular dilation. Conclusi ons: Our technique allows tricuspid valve repair in patients with Ebst ein's anomaly, even in cases usually reserved for primary valve replac ement, without late functional deterioration.