Surgical Treatment of Ebstein Anomaly in Two Adult Cases: Limitations and Difficulties of Carpentier's Procedure

(Department of Cardiovascular Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan and Department of Surgery, Hokkaido Kin-I-Kyou Central Hospital, Sapporo, Japan and Department of Surgery, Hokkaido Kin-I-Kyou Central Hospital*, Sapporo, Japan)

Tomoji Yamakawa* Toshihumi Murashita Jun-ichi Oka
Takehiro Kubota Michiaki Imamura Norihiko Shiiya
Keishu Yasuda
In repair of the tricuspid valve (TV) due to Ebstein's anomaly, mobilization of the anterior leaflet associated with longitudinal right ventricle plication (Carpentier's procedure) has provided good results in both short- and long-term follow-up. However, if the anterior leaflet is small or severely deformed, such repair may be ineffective. We report two cases of Ebstein's anomaly (63 and 53 years old) with deformed anterior leaflets of the TV in whom Carpentier's procedure was not feasible. In one patient, the anterior leaflets were broadly plastered on the right ventricle and Carpentier's procedure was tried. However, the repair was converted to valve replacement because of significant residual regurgitation. The other patient had a cleft in the anterior leaflet, therefore Carpentier's procedure was not suitable. The repair restructured the valve mechanism below the true annulus by using the most mobile leaflets for valve closure (modified Hetzer's procedure). This method of repair could be an alternative method to repair of the TV in Ebstein's anomaly, particularly when the anterior leaflet is deformed.
@Jpn. J. Cardiovasc. Surg. 31: 414-417 (2002)