title: Improvements in exercise performance after surgery for Ebstein anomaly.
abstract: OBJECTIVE
  The purpose of this longitudinal study was to assess improvements in exercise performance and quality of life in patients with Ebstein anomaly after surgical intervention.
  
  
  METHODS
  In 21 patients with Ebstein anomaly (between 6 and 59 years of age; 16 female, 5 male) who underwent surgery for tricuspid regurgitation and, if present, closure of an interatrial shunt, a cardiopulmonary exercise test and a quality-of-life assessment by the Medical Outcomes Study 36 item short form was performed prior to and 6 to 18 months after surgery.
  
  
  RESULTS
  After surgery, peak oxygen uptake increased from 68.4% of predicted to 77.3% of predicted (P = .009), and ventilatory efficiency (VE/VCO(2) slope) improved from 32.5 to 29.3 (P = .001). In 14 patients with additional interatrial shunt closure, oxygen saturation improved from 95% to 99% at rest (P = .003) and from 88% to 99% under peak exercise (P = .003). Improvements in VE/VCO(2) slope were similar in patients who had undergone primary surgery (P = .005) or reoperation (P = .018). Increase in exercise capacity was also similar in both groups but failed significance in both (primary surgery, P = .064; reoperation, P = .063). There was no difference between tricuspid valve repair and replacement in the short-term follow-up. Self-estimated quality of life was fairly good prior to and after surgery. Only in the single question about health transition at follow-up did the patients confirm an improved situation after surgery.
  
  
  CONCLUSIONS
  Patients with Ebstein anomaly and severe tricuspid regurgitation draw clinical benefit from surgical intervention as measured on exercise testing. This holds true for primary surgery and for reoperation.
authors.affiliation: Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Germany. muellerjan@dhm.mhn.de
authors.forename: Jan
authors.initials: J
authors.lastname: Müller
authors.forename: Andreas
authors.initials: A
authors.lastname: Kühn
authors.forename: Manfred
authors.initials: M
authors.lastname: Vogt
authors.forename: Christian
authors.initials: C
authors.lastname: Schreiber
authors.forename: John
authors.initials: J
authors.lastname: Hess
authors.forename: Alfred
authors.initials: A
authors.lastname: Hager
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures; D002648:Child; D004437:Ebstein Anomaly / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D005858:Germany; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011788:Quality of Life; D020127:Recovery of Function; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult