title: Application of Cone Reconstruction for Neonatal Ebstein Anomaly or Tricuspid Valve Dysplasia.
abstract: BACKGROUND
  Outcomes of surgical intervention for severe tricuspid regurgitation related to Ebstein anomaly or tricuspid valve dysplasia in the neonatal period, particularly when associated with pulmonary atresia, are extremely poor. However, owing to emerging innovative surgical techniques, such as cone reconstruction, outcomes of tricuspid valve plasty in the neonatal period have gradually improved.
  
  
  METHODS
  The study retrospectively reviewed the medical records of 12 neonates who were diagnosed with severe tricuspid regurgitation and pulmonary atresia related to Ebstein anomaly (n = 9) or isolated tricuspid valve dysplasia (n = 3) between 2000 and 2013.
  
  
  RESULTS
  The first 6 patients underwent palliative therapy in anticipation of future functional single-ventricle palliation (Starnes operation). Biventricular repair was performed in the 6 patients born after 2012. As tricuspid valve plasty, cone reconstruction has been applied since 2013. Five patients underwent a Starnes operation, and 5 patients underwent biventricular repair, including 4 cone reconstructions. Four of the 5 patients who underwent a Starnes operation died in-hospital; the remaining patient underwent a Fontan operation at age 2 years. Three of the 5 patients who underwent biventricular repair survived. On echocardiogram, the 3 survivors who were treated with biventricular repair had a preoperative tricuspid regurgitation flow velocity greater than 3.0 m/s.
  
  
  CONCLUSIONS
  Biventricular repair with cone reconstruction can be applied for severe tricuspid regurgitation due to neonatal Ebstein anomaly or tricuspid valve dysplasia with associated pulmonary atresia. A tricuspid regurgitation flow velocity greater than 3.0 m/s may be an indicator of successful biventricular repair.
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Mizuno
authors.affiliation: Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. Electronic address: thoashi@surg1.med.osaka-u.ac.jp.
authors.forename: Takaya
authors.initials: T
authors.lastname: Hoashi
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Heima
authors.initials: H
authors.lastname: Sakaguchi
authors.affiliation: Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kagisaki
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Kitano
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kurosaki
authors.affiliation: Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Yoshimatsu
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Shiraishi
authors.affiliation: Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Ichikawa
mesh_terms: D000015:Abnormalities, Multiple; D002303:Cardiac Output, Low / Q000401:mortality; D015897:Comorbidity; D004437:Ebstein Anomaly / Q000601:surgery*; D005260:Female; D005865:Gestational Age; D017052:Hospital Mortality; D006801:Humans; D015160:Hydrops Fetalis / Q000453:epidemiology; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000503:physiopathology / Q000601:surgery; D008297:Male; D010166:Palliative Care; D011183:Postoperative Complications / Q000401:mortality; D018633:Pulmonary Atresia / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000002:abnormalities* / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*