title: Da Silva's cone repair for Ebstein's anomaly: effect on right ventricular size and function.
abstract: OBJECTIVE
  Da Silva's cone repair is a novel technique for surgical reconstruction of the tricuspid valve and the right ventricle (RV) in Ebstein's anomaly. The technique consists of extensive leaflet mobilization, longitudinal plication of the atrialized ventricle and cone-shaped reconstruction of the tricuspid valve, allowing for leaflet-to-leaflet coaptation. We evaluated the influence of Da Silva's cone repair on tricuspid competency, right ventricular size and function.
  
  
  METHODS
  From February 2010 until July 2013, 20 patients (median age 30.0 years, range 6.6-68.3 years) underwent Da Silva's cone repair. A 4- to 6-mm interatrial communication was left in all patients. Echocardiographic studies and magnetic resonance imaging (MRI) before and after the repair were evaluated.
  
  
  RESULTS
  Median follow-up was 11 (0.5-36) months. There were 2 early deaths and no late death. Echocardiography at follow-up revealed mild or absent tricuspid regurgitation in 16 patients. Two patients showed moderate tricuspid insufficiency. MRI studies showed that the mean functional RV end-diastolic volume decreased after surgery (pre 334 [135-656] ml; post 175 [115-404] ml, P < 0.001). The mean RV ejection fraction decreased (pre 47 ± 10%; post 35 ± 13%, P = 0.001), and the mean antegrade net stroke volume of the RV increased (pre 65 ± 28 ml; post 75 ± 30 ml, P = 0.057).
  
  
  CONCLUSIONS
  Da Silva's cone repair for Ebstein's anomaly creates excellent valve function in all patients. Consecutively, the size of the RV decreases and the antegrade net stroke volume increases 6 months after the operation.
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany DZHK (German Center for Cardiovascular Research)-partner site Munich Heart Alliance, Munich, Germany lange@dhm.mhn.de.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Lange
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany.
authors.forename: Melchior
authors.initials: M
authors.lastname: Burri
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany.
authors.forename: Lena Katharina
authors.initials: LK
authors.lastname: Eschenbach
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany.
authors.forename: Catalin Constantin
authors.initials: CC
authors.lastname: Badiu
authors.affiliation: Cardiovascular Surgery Division, Hospital Beneficencia Portuguesa de São Paulo Escola Paulista de Medicina-UNIFESP, São Paulo, Brazil.
authors.forename: José Pedro
authors.initials: JP
authors.lastname: da Silva
authors.affiliation: Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich at the Technical University Munich, Munich, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Nagdyman
authors.affiliation: Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich at the Technical University Munich, Munich, Germany.
authors.forename: Sohrab
authors.initials: S
authors.lastname: Fratz
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hörer
authors.affiliation: Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich at the Technical University Munich, Munich, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kühn
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schreiber
authors.affiliation: Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich at the Technical University Munich, Munich, Germany.
authors.forename: Manfred Otto
authors.initials: MO
authors.lastname: Vogt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004437:Ebstein Anomaly / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery; D014463:Ultrasonography; D016278:Ventricular Function, Right / Q000502:physiology*; D055815:Young Adult
keywords: Congenital heart disease; Magnetic resonance imaging; Surgery techniques; Tricuspid valve; Ventricle right; valve