Tricuspid valve surgery improves cardiac output and exercise performance in patients with Ebstein's anomaly.
BACKGROUND
Clinical, hemodynamic and functional effects of tricuspid valve surgery in patients with Ebstein's anomaly are not well understood.


METHODS
Sixteen patients (median age of 27.7 years) were examined before and eight months after surgery by means of echocardiography, cardiovascular magnetic resonance (CMR) and cardiopulmonary exercise testing.


RESULTS
Peak work load (1.87 to 2.0W/kg; p=0.026), maximum oxygen uptake (21 to 22 ml/kg/min; p=0.034) as well as cardiac output (2.7 to 2.9l/min/m(2); p=0.035) increased postoperatively. The reduction of tricuspid regurgitation led to a higher pulmonary stroke volume (29 to 42ml/m(2), p=0.005) and augmented the left ventricular (LV) volume (55 to 63ml/min/m(2); p=0.001) with a trend to better ejection fraction (61 to 64%; p=0.083). Right ventricular (RV) volume index (124 to 108ml/m2; p=0.034) and ejection fraction (50 to 42%; p=0.036) decreased on CMR. Echocardiographic measurements of RV function also decreased (tricuspid annular plane systolic excursion 2.3 to 1.7; p=0.002; isovolumic acceleration 0.98 to 0.65; p=0.004; and 2-d longitudinal global strain -19.3 to -16.25; p=0.006).


CONCLUSIONS
Tricuspid valve surgery improves exercise capacity in patients with Ebstein's anomaly. The reduction of tricuspid regurgitation decreases the volume of the right ventricle and increases pulmonary antegrade flow. As a result LV volume and cardiac output increase. This hemodynamic benefit occurs despite the preload dependent reduction in RV volume and ejection fraction.
Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Andreas
A
Kühn
Gabriella
G
De Pasquale Meyer
Jan
J
Müller
Kurt
K
Petzuch
Sohrab
S
Fratz
Christoph
C
Röhlig
Alfred
A
Hager
Christian
C
Schreiber
John
J
Hess
Manfred
M
Vogt
D000293:Adolescent; D000328:Adult; D000368:Aged; D002302:Cardiac Output / Q000502:physiology*; D002648:Child; D004437:Ebstein Anomaly / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014261:Tricuspid Valve / Q000502:physiology* / Q000601:surgery*; D055815:Young Adult