title: More than valve repair: Effect of cone reconstruction on right ventricular geometry and function in patients with Ebstein anomaly.
abstract: BACKGROUND
  Cone reconstruction is a novel surgical procedure for tricuspid valve repair in Ebstein anomaly. This study examined the effect of cone reconstruction on right ventricle (RV) geometry, function, and synchronization.
  
  
  METHODS
  Twenty-one patients (4-49 year-old) underwent cone reconstruction were enrolled, and matched with healthy individuals. Pre-operative and follow-up echocardiography was performed along with cardiac magnetic resonance (CMR) imaging in 18 patients. A new parameter, tricuspid annular movement synchronicity index (TAMSI), was used to describe global synchronization of RV in the annular plane. TAMSI was defined as standard deviation of the systolic excursion of the hinge points of the three leaflets divided by their average value.
  
  
  RESULTS
  After 9.1 (range 1-12) months follow-up, there were no deaths; tricuspid regurgitation was reduced from moderate/severe to mild or less in 95.2% of patients. In 18 patients with both pre and post CMR data, functional RV volume decreased after repair (134.3 ± 58.3 ml/m(2) to 96.6 ± 29.6 ml/m(2); P=0.001), while ejection fraction was not significantly altered (38.2 ± 9.2% to 36.5 ± 8.5%; P=0.357). TAMSI was significantly reduced after surgery, from 0.613 ± 0.220 to 0.169 ± 0.088 (P<0.001). A value similar to the normal control (0.181 ± 0.081) indicated more synchronized RV movement pattern.
  
  
  CONCLUSIONS
  Cone reconstruction yielded good short-term survival in Ebstein anomaly. It reduced functional RV volume, improved RV global synchronization, and restored RV geometry. As such, it may improve RV performance and long-term prognosis. In addition, our described TAMSI proved to be a useful adjunct to postoperative assessments.
authors.affiliation: Department of Cardiovascular Surgery/Pediatric Heart Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Si-Meng
authors.initials: SM
authors.lastname: Wang
authors.affiliation: Department of Cardiothoracic 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 Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Cheng
authors.affiliation: Department of Cardiovascular Surgery/Pediatric Heart Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Lin
authors.affiliation: Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Jia-Yu
authors.initials: JY
authors.lastname: Sun
authors.affiliation: Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Yang
authors.affiliation: Department of Cardiovascular Surgery/Pediatric Heart Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Shu-Hua
authors.initials: SH
authors.lastname: Luo
authors.affiliation: Department of Cardiovascular Surgery/Pediatric Heart Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: An
authors.affiliation: Department of Cardiology/Pediatric Heart Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address: chenyucheng2003@126.com.
authors.forename: Yu-Cheng
authors.initials: YC
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004437:Ebstein Anomaly / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006321:Heart / Q000033:anatomy & histology / Q000503:physiopathology; D006352:Heart Ventricles / Q000033:anatomy & histology; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016278:Ventricular Function, Right; D055815:Young Adult
keywords: Cardiac magnetic resonance (CMR); Cone reconstruction; Ebstein anomaly; Right ventricle; Tricuspid annular movement synchronicity index (TAMSI)