title: Cone reconstruction in Ebstein's anomaly repair: early and long-term results.
abstract: BACKGROUND
  The main Ebstein anomaly (EA) repairs are based on the monocusp reconstruction of the tricuspid valve and are limited by the frequent need for replacement or the high recurrence of valve regurgitation.
  
  
  OBJECTIVE
  To evaluate the feasibility and effects of anatomical repair of Ebstein's anomaly using the cone reconstruction technique on patients' clinical evaluation, tricuspid valve function and right ventricular morphology.
  
  
  METHODS
  We compared the clinical, echocardiographic and radiological data of 52 consecutive patients, with a mean age of 18.5 ± 13.8 years, submitted to the cone reconstruction technique, obtained in the preoperative, early postoperative (EPO) and long-term (LPO) periods.
  
  
  RESULTS
  There were two in-hospital deaths (3.8%) and two more during the follow-up. Mean functional class of pre-operative heart failure improved from 2.2 to 1.2 after 57 months of mean follow up of 97% of patients (p <0.001). The mean degree of preoperative tricuspid regurgitation decreased from 3.6 to 1.6 in the EPO (p <0.001), remaining at 1.9 in LPO period (p> 0.05). The indexed RV functional area increased from 8.53 ± 7.02 cm²/m² preoperatively to 21.01 ± 6.87 cm²/m² in the EPO (p <0.001) and remained unchanged at 20.28 ± 5.26 cm²/m² in LPO period (p> 0.05). The mean cardiothoracic ratio was decreased from 0.66 ± 0.09 to 0.54 ± 0.06 (p <0.001) in the long term.
  
  
  CONCLUSIONS
  The cone technique showed low in-hospital mortality, resulting in an effective and long-lasting repair of tricuspid regurgitation, restoring the functional area of the right ventricle and allowing reverse remodeling of the heart and clinical improvement in most patients in the long term.
authors.affiliation: Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. dasilvajp@uol.com.br
authors.forename: José Pedro da
authors.initials: JP
authors.lastname: Silva
authors.forename: Luciana da Fonseca da
authors.initials: Lda F
authors.lastname: Silva
authors.forename: Luiz Felipe P
authors.initials: LF
authors.lastname: Moreira
authors.forename: Lilian Maria
authors.initials: LM
authors.lastname: Lopez
authors.forename: Sônia Meiken
authors.initials: SM
authors.lastname: Franchi
authors.forename: Alessandro Cavalcante
authors.initials: AC
authors.lastname: Lianza
authors.forename: José Francisco
authors.initials: JF
authors.lastname: Baumgratz
authors.forename: Glaucia Maria P
authors.initials: GM
authors.lastname: Tavares
mesh_terms: D000293:Adolescent; D001938:Brazil / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000401:mortality; D004437:Ebstein Anomaly / Q000401:mortality / Q000601:surgery*; D004452:Echocardiography; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011184:Postoperative Period; D057234:Preoperative Period; D014261:Tricuspid Valve / Q000601:surgery*