title: Combination of a Hetzer operation and a Sebening stitch for Ebstein's anomaly.
abstract: OBJECTIVE
  In order to improve the function of the anterior leaflet as a monocusp valve in tricuspid valve repair for Ebstein's anomaly, a single-stitch technique after Sebening, creating a hinge point of the anterior leaflet on the ventricular septum on the opposite side, was newly incorporated into the Hetzer operation (either posterior annulorrhaphy or the double-orifice technique). We describe the operative technique of the modified operation and present the initial results.
  
  
  METHODS
  Eleven patients who underwent the modified operation were involved in the study. Tricuspid valve function was assessed by echocardiography preoperatively and 3 months after the operation. Its improvement was studied, and compared with that after the conventional Hetzer operation (n=15).
  
  
  RESULTS
  After a mean follow-up period of 18.4 months (range 8.2-32.6 months), there were no early deaths and no cases of reoperation on the tricuspid valve in patients who had undergone the modified operation. At the last follow-up, 7 patients were in New York Heart Association class I, and 4 patients were in class II. The function of the tricuspid valve was significantly improved 3 months after the modified operation (P < 0.01, Wilcoxon signed-ranks test). Among the patients with Carpentier's classification type A or B, 85.7% of patients showed a tricuspid valve regurgitation (TR) grade of less than 2 after the modified operation, and this rate was significantly higher than that of 30.0% of patients in the group who underwent the conventional operation, (P < 0.05, Fisher's exact test).
  
  
  CONCLUSIONS
  The initial results of the new modification are satisfactory. However, a further follow-up and an accumulation of operative cases are necessary.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. komoda@dhzb.de
authors.forename: Takeshi
authors.initials: T
authors.lastname: Komoda
authors.forename: Satsuki
authors.initials: S
authors.lastname: Komoda
authors.forename: Nicole
authors.initials: N
authors.lastname: Nagdyman
authors.forename: Felix
authors.initials: F
authors.lastname: Berger
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004437:Ebstein Anomaly / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D014261:Tricuspid Valve / Q000601:surgery