Tricuspid annuloplasty and ventricular plication for Ebstein's malformation.

BACKGROUND: Seven patients with the diagnosis of Ebstein's malformation of the tricuspid valve were operated on. Mean age was 12 years (range, 7 to 16 years). All were cyanotic, with severe tricuspid regurgitation. Thromboembolism was not present. No associated cardiac malformations were present. METHODS: Surgical repair included tricuspid annuloplasty associated with longitudinal plication of the atrialized portion of the right ventricle. This was attained by approximating the anterior-posterior commissure with either the posterior-septal commissure or the septal leaflet remnant. The thin atrialized ventricular wall thus excluded remained as a cul du sac and was plicated by suturing along the longitudinal axis of the heart. When present, the dysplastic posterior leaflet was included in the plication. In essence, a monocuspid right atrioventricular valve was fashioned out of the anterior leaflet. The remaining septal leaflet played a minimal functional role. No additional procedures for treatment of arrhythmia were associated with the technique described. RESULTS: The postoperative course was uneventful in all patients. Mean follow-up is 4.3 years (range, 1 to 10 years). Doppler echocardiographic studies reveal satisfactory monocusp valve function in all patients, with adequate coaptation of the anterior leaflet and the septal structures. CONCLUSIONS: This technique seems applicable to most forms of Ebstein's malformation and is reproducible. The technique relies on the adequate mobilization of the anterior leaflet. Occasionally it is necessary to free fibrous adhesions of the leaflet to the underlying ventricular surface.

Databases, websites, and the Internet.

By the end of the year 2000, an estimated 100 to 500 million computers may be linked to the Internet, representing an enormous level of information exchange. Even today, a broad Internet search of a term such as "breast cancer" can produce an overwhelming list of web pages, most of which will not be of interest to the typical Internet user. A more sophisticated user such as the oncology professional will more likely refine the search by adding other terms, producing a more manageable and useful list of websites. Information on cancer can be readily accessed from thousands of websites developed by the government, medical organizations, other institutions, medical journals, patient support groups, and pharmaceutical companies, as well as through medical web directories. The Cancer Information Network (CIN), an independent website geared to the oncology community, provides access to Medline, PDQ, and hundreds of cancer-related resources on the World Wide Web. CIN also offers the complete NCCN conference proceedings and practice guidelines; full text of several medical journals, textbooks, and handbooks; a daily oncology news service; a clinically oriented drug reference guide; and an extensive calendar of medical meetings and CME courses.