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Ann Thorac Surg 2004;77:476
© 2004 The Society of Thoracic Surgeons

Invited commentary

Roger B. B. Mee, MB, ChB, FRACS

Department of Pediatric and Congenital Heart Surgery, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA

e-mail: meer{at}ccf.org


This article has been selected for the open discussion forum on the CTSNet Web site: http://www.ctsnet.org/discuss

 

In their paper, Wu and Huang have described a new technique of handling Ebstein's anomaly of the tricuspid valve.

Their 34 consecutive patients have yielded outstanding early results. Their repair has been directed towards the septal and posterior leaflets, replacing the septal leaflet if necessary with a fresh autologous pericardial prosthesis. They have stated that the method is applicable to nearly all Ebstein's anomalies, except those with hypoplastic anterior leaflets. Presumably exclusion criteria would also include those patients with a large anterior leaflet that is widely adherent to the free wall of the right ventricle. Their method does not indicate any adjustment of the anterior leaflet as described by Carpentier. The reduction in annular size and excision of large atrialized portions of the right ventricle is common to previously described repairs.

The short-term function of the tricuspid valve in eight patients with fresh autologous pericardial replacement of the septal leaflet has been good. There will be some skepticism about the durability of this leaflet replace-ment. It would be beneficial for the authors to provide follow-up in 2 to 3 years with additional cases and longer follow-up.

In the meantime, the authors of this new technique are to be congratulated for devising this new technique and on the superb results.





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