Targeted drug delivery systems for matrix metalloproteinase-responsive anoparticles in tumor cells: A review.

Nanodrug delivery systems based on tumor microenvironment responses have shown excellent performance in tumor-targeted therapy, given their unique targeting and drug-release characteristics. Matrix metalloproteinases (MMPs) have been widely explored owing to their high specificity and expression in various tumor microenvironments. The design of an enzyme-sensitive nanodelivery system using MMPs as targeted receptors could markedly improve the performance of drug targeting. The current review focuses on the development and application of MMP-responsive drug carriers, and summarizes the classification of single- and multi-target nanocarriers based on their MMP responsiveness. The potential applications and challenges of this nanodrug delivery system are discussed to provide a reference for designing high-performance nanodrug delivery systems.

Synergistic effects of multidrug/material combination deliver system for anti-mutidrug-resistant tumor.

Multidrug resistance (MDR) is a public health issue of particular concern, for which nanotechnology-based multidrug delivery systems are considered among the most effective suppressive strategies for such resistance in tumors. However, for such strategies to be viable, the notable shortcomings of reduced loading efficiency and uncontrollable drug release ratio need to be addressed. To this end, we developed a novel "multidrug/material" co-delivery system, using d-α-tocopheryl polyethylene glycol 1000 succinate (TPGS, P-gp efflux pump inhibitor) and poly(amidoamine) (PAMAM) to fabricate a precursor material with the properties of reversing MDR and having a long-cycle. Further, to facilitate multidrug co-delivery, we loaded doxorubicin(Dox) and curcumin(Cur, cardiotoxicity modifier and P-gp inhibitor) into PAMAM-TPGS nano-micelles respectively, and mixed in appropriate proportions. The multidrug/material co-delivery system thus obtained was characterized by high drug loading and a controllable drug release ratio in the physiological environment. More importantly, in vitro and in vivo pharmacodynamic studies indicated that the multidrug/material co-delivery system facilitated the reversal of MDR. Moreover, the system has increased anti-tumor activity and is biologically safe. We accordingly propose that the "multidrug/material" co-delivery system developed in this study could serve as a potential platform for reversing MDR and achieving safe and effective clinical treatment.

Protein corona, influence on drug delivery system and its improvement strategy: A review.

Nano drug delivery systems offer several benefits, including enhancing drug solubility, regulating drug release, prolonging drug circulation time, and minimized toxicity and side effects. However, upon entering the bloodstream, nanoparticles (NPs) encounter a complex biological environment and get absorbed by various biological components, primarily proteins, leading to the formation of a 'Protein Corona'. The formation of the protein corona is affected by the characteristics of NPs, the physiological environment, and experimental design, which in turn affects of the immunotoxicity, specific recognition, cell uptake, and drug release of NPs. To improve the abundance of a specific protein on NPs, researchers have explored pre-coating, modifying, or wrapping NPs with the cell membrane to reduce protein adsorption. This paper, we have reviewed studies of the protein corona in recent years, summarized the formation and detection methods of the protein corona, the effect of the protein corona composition on the fate of NPs, and the design of new drug delivery systems based on the optimization of protein corona to provide a reference for further study of the protein corona and a theoretical basis for the clinical transformation of NPs.

Strategy and technique for surgical treatment of Ebstein's anomaly.

BACKGROUND: Ebstein's anomaly (EA) is a rare and complex congenital heart anomaly, and the effect of surgical treatment is not ideal. This study aims to introduce our experience in management strategies, surgical techniques, and operative indications for patients with Ebstein's anomaly. METHODS: A retrospective study of 258 operations was performed in 253 patients by the same cardiac surgeon in The First Hospital of Tsinghua University between March 2004 and January 2020. 32 patients had previously received cardiac surgery in other hospitals. The clinical data including diagnosis, operative indications, techniques, pathological changes, and survival rates were collected and analyzed. RESULTS: Anatomical correction was performed in 203 (78.7%) operations, 1½ ventricle repair in 38 (14.7%) operations, tricuspid valve repair only in four operations (1.6%), tricuspid valve replacement in ten (3.9%), total cavopulmonary connection (TCPC) in two (0.8%), and Glenn operation in one operation (0.4%). Reoperation was performed in five patients (2.0%) during hospitalization. Among them, tricuspid valve replacement was performed in one patient, 1½ ventricle repair in two patients, and tricuspid valve annulus reinforcement in two patients. Five patients died with an early mortality rate of 2.0%. Complete atrioventricular conduction block was complicated in one patient (0.4%). A total of 244 patients was followed up (four in the 253 patients lost) with a duration of 3.0-168.0 (87.6 ± 38.4) months. Cardiac function of 244 patients improved significantly with mean New York Heart Association (NYHA) functional class recovery from 3.5 to 1.1. The mean grade of tricuspid valve regurgitation improved from 3.6 to 1.5. Three late deaths (1.2%) occurred. The survival rates at five and ten years after surgery were 98.6% and 98.2%, respectively. Reoperation was performed in five patients (2.0%) during the follow-up period. CONCLUSION: Based on our management strategies and operative principles and techniques, anatomical correction of EA is capable of achieving excellent long-term results, and low rates of TCPC, 1½ ventricle repair and valvular replacement.

The value of right heart contrast echocardiography combined with migraine rating scale in evaluating the efficacy of patent foramen ovale closure.

OBJECTIVES: To investigate the clinical values of right heart contrast transthoracic echocardiography (cTTE) combined with migraine rating scale in evaluating the efficacy of patent foramen ovale (PFO) closure. METHODS: From January 2018 to December 2021, a total of 68 hospitalized patients, 21 males and 47 females, who were treated with transcatheter closure of PFO-induced migraine in the Heart Center of the First Affiliated Hospital of Tsinghua University were selected, with the age of 38.4 ± 11.9 years old. The changes of right heart contrast transthoracic echocardiography (cTTE), visual analogue pain score(VAS), headache impact test-6(HIT-6) and migraine disability assessment questionnaire(MIDAS) before and 6 months after PFO occlusion were compared. RESULTS: Pre-operative cTTE data show that 36 patients (52.9%) had moderate right-to-left shunt (RLS), and 32 patients (47.1%) had massive RLS. cTTE was reexamined 6 months after operation and 1 case in the moderate RLS group had minimal RLS, 2 cases in the large RLS group had minimal RLS, and no shunts were seen for the rest. The VAS, HIT-6 and MIDAS scores before and 6 months after the operation were 7.65 ± 1.39 vs. 1.28 ± 1.53, 70.78 ± 6.82 vs. 41.53 ± 6.07, and 30.60 ± 13.24 vs. 1.93 ± 3.87, respectively. All the indexes 6 months after the operation significantly improved compared with the preoperative baseline (P < 0.05). CONCLUSIONS: cTTE combined with migraine evaluation scale could be used as an objective index to evaluate the clinical effect of PFO occlusion.

The Photocatalytic Performance of P, Cl Doped Carboxylated Multiwalled Carbon Nanotube Modified Graphitic Carbon Nitride.

Graphitized carbonitride (g-C3N4) is widely used in CO2 reduction, hydrogen production, and degradation of toxic chemical dyes and antibiotics. It is a kind of photocatalytic material with excellent performance, and it has the advantages of being safe and nontoxic, having a suitable band gap (2.7 eV), and having a simple preparation and high stability, but because of its fast optical recombination speed and low visible light overutilization, the multifunctional application of g-C3N4 is seriously hindered. Compared with pure g-C3N4, MWCNTs/g-C3N4 have a red-shift in the visible range and a strong absorption in the visible region. Melamine and carboxylated multiwalled carbon nanotubes were used as raw materials to successfully prepare CMWCNT modified g-C3N4 doped with P, Cl by a high temperature calcination method. The effect of the addition amount of P, Cl on the photocatalytic performance of modified g-C3N4 was studied. The experimental results show that the multiwalled carbon nanotubes can accelerate the electron migration, and the doping of P, Cl elements can change the energy band structure of g-C3N4 and reduce the band gap. Through fluorescence analysis and photocurrent analysis, it is known that the incorporation of P, Cl reduces the recombination efficiency of photogenerated electron-hole pairs. In order to explore the application in the degradation of chemical dyes, the photocatalytic degradation efficiency of RhB under visible light was studied. The photocatalytic performance of the samples was evaluated by photodecomposition of aquatic hydrogen. The results showed that when the amount of ammonium dihydrogen phosphate was 10 wt %, the photocatalytic degradation efficiency was the highest, which was 21.13 times higher than that of g-C3N4.

Feasibility of ultrasound in the diagnosis of neonatal respiratory distress syndrome in preterm infants.

BACKGROUND: The aim of this study was to investigate the feasibility of lung ultrasound in the diagnosis of neonatal respiratory distress syndrome (NRDS) in preterm infants. METHODS: One hundred and nine preterm infants were prospectively recruited. Three ultrasound diagnostic criteria were developed to diagnose preterm infants with NRDS: (A) thickened or not smooth pleural line, part of the lung field shows diffuse 'B-line' sign or alveolar-interstitial syndrome (AIS); (B) thickened or not smooth pleural line, all lung fields show AIS, signifying the 'white lung' sign; (C) thickened or rough pleural line, 'white lung' sign and 'lung consolidation' sign can be observed in any lung field. RESULTS: The sensitivity and negative predictive value of NRDS in preterm infants with diagnostic criteria A were 100%, but the specificity and positive predictive value were 67.95 and 55.36%, respectively. The specificity and positive predictive value of diagnostic criteria B and C were 100%, while the 95% CI of diagnostic criteria B was narrower than diagnostic criteria C. The sensitivity and negative predictive value of diagnostic criteria B were higher than that of diagnostic criteria C. Of the 31 NRDS cases, 15 cases had severe NRDS and the other 16 did not have severe NRDS. CONCLUSION: Thickened or rough pleural line with white lung sign is an important characteristic for the diagnosis of NRDS by lung ultrasound. White lung sign combined with the lung consolidation sign had high diagnostic efficacy when distinguishing severe NRDS from not severe NRDS.

Nomenclature for Pediatric and Congenital Cardiac Care: Unification of Clinical and Administrative Nomenclature - The 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11).

Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC.The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.

Nomenclature for Pediatric and Congenital Cardiac Care: Unification of Clinical and Administrative Nomenclature - The 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11).

Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC.The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.

Strain and Strain Rate To Evaluate Right Heart Function of Ebstein Anomaly (EA) Patients Before and After Operation.

OBJECTIVE: This study was aimed to elucidate the feasibility of using right ventricular (RV) strain and strain rate to evaluate right heart function of Ebstein anomaly (EA) patients before and after operation. METHODS: Sixty EA patients and 30 healthy controls underwent echocardiography (UCG) for evaluation of right heart function. Preoperative UCG and 1-week and 3-month postoperative UCG were performed in EA patients. RV strain and strain rate were measured on the four-chamber section of tissue Doppler imaging (TDI). RESULTS: The strain and strain rate representative of right ventricle systolic function were reduced prior to operation. RV strain and strain rate improved after the operation (P < .001), most significantly in the basal segment and middle segment of the free wall of the right ventricle as well as the basal segment of the interventricular septum (P < .001). CONCLUSIONS: The measurement of RV strain and strain rate on tissue Doppler imaging can be employed to assess the preoperative and postoperative RV function, proves the positive effect of tricuspid valve repair on right heart function, and offers more insight on right heart function evaluation.

Social Support and Well-Being of Chinese Special Education Teachers-An Emotional Labor Perspective.

Due to their high expectations, teachers often hide their real emotions and play a role that conforms to public expectations of educational work. Special education teachers face a group of students with physical and mental disabilities who have high heterogeneity and require individualized services every day. Using social support theory, this study discusses special education teachers' emotional labor and well-being. A total of 439 special education teachers in China participated in this study. We collected data at two different time-points and verified the research hypotheses with hierarchical regression and structural equation modeling analysis. The research findings show the mediating role of emotional labor in social support and well-being. It is, therefore, suggested that schools should pay more attention to special education teachers' mental health and provide them with regular guidance and support.

Exploring Links between Polychronicity and Job Performance from the Person-Environment Fit Perspective-The Mediating Role of Well-Being.

Polychronicity refers to the preference of some individuals to structure their time in order to deal with multiple tasks simultaneously in a short period of time. Past research regarding the correlation between individual polychronicity and performance presented distinct arguments. Although most studies supported a positive correlation with performance, empirical findings showed inconsistent results, indicating the presence of other influencing factors. According to the person-environment fit theory and self-determination theory, the effect of polychronicity on job performance was verified and the mediation effect of well-being was tested in this study. Dual-mode questionnaires were collected from 532 subordinators and their direct supervisors in 98 chain restaurants and hierarchical regression analysis was performed to test the research hypotheses. The results showed that polychronicity positively affected well-being, that is, well-being was a full mediator between polychronicity and job performance. This study provides valuable insight for managers to understand employee polychronicity and, in turn, improve their well-being, which could help improve job performance.

Classification of Ventricular Septal Defects for the Eleventh Iteration of the International Classification of Diseases-Striving for Consensus: A Report From the International Society for Nomenclature of Paediatric and Congenital Heart Disease.

The definition and classification of ventricular septal defects have been fraught with controversy. The International Society for Nomenclature of Paediatric and Congenital Heart Disease is a group of international specialists in pediatric cardiology, cardiac surgery, cardiac morphology, and cardiac pathology that has met annually for the past 9 years in an effort to unify by consensus the divergent approaches to describe ventricular septal defects. These efforts have culminated in acceptance of the classification system by the World Health Organization into the 11th Iteration of the International Classification of Diseases. The scheme to categorize a ventricular septal defect uses both its location and the structures along its borders, thereby bridging the two most popular and disparate classification approaches and providing a common language for describing each phenotype. Although the first-order terms are based on the geographic categories of central perimembranous, inlet, trabecular muscular, and outlet defects, inlet and outlet defects are further characterized by descriptors that incorporate the borders of the defect, namely the perimembranous, muscular, and juxta-arterial types. The Society recognizes that it is equally valid to classify these defects by geography or borders, so the emphasis in this system is on the second-order terms that incorporate both geography and borders to describe each phenotype. The unified terminology should help the medical community describe with better precision all types of ventricular septal defects.

Intraoperative Transesophageal Echocardiography in the Operation of Ebstein's Anomaly: A Retrospective Study.

BACKGROUND: Ebstein's anomaly (EA) has various spectrums in clinical and anatomic features. This study aimed to report the experience of two-dimensional intraoperative transesophageal echocardiography (2D-ITEE) during the EA surgery and to analyze the characteristics of the tricuspid valve (TV) by comparing the data from 2D-ITEE with the results from the surgery. METHODS: 2D-ITEE data of 164 patients with EA who were operated in the First Hospital of Tsinghua University between July 2004 and April 2014 were retrospectively analyzed in this study. 2D-ITEE was applied in all patients. Downward displacement distances were measured, and the numbers of downward displacement or absent leaflets were compared with that of the surgery and with that of the two-dimensional-transthoracic echocardiogram (2D-TTE). Data comparison was performed using the Chi-square test. RESULTS: The anterior leaflet partial or total downward displacement was 37.76 ± 17.50 mm in 54 cases, absent in one patient; septal leaflet downward displacement was 29.07 ± 12.34 mm in 134 cases, absent in 17 cases; and posterior leaflet downward displacement was 43.18 ± 19.16 mm in 115 cases, absent in 34 cases. Statistically, there was no significant difference between the results from 2D-ITEE and that of 2D-TTE. The consistency rates of 2D-ITEE with operation for septal and posterior leaflets were 93.2% and 96.1%, respectively, while the rate for anterior was only 40.1%, which was significantly different. Color Doppler flow image showed severe regurgitation in 150 cases and moderate in 14 cases. After surgical correction, moderate regurgitation of TV was found in 58 cases with 2D-ITEE, repair was performed again until the effect was satisfied. No complication occurred relating to the use of 2D-ITEE. CONCLUSIONS: 2D-ITEE could help diagnose anterior leaflet, evaluate the effect of TV repair, increase operational success rate, and reduce complication.

Persistent fifth aortic arch with interrupted aortic arch.

Persistent fifth aortic arch (PFAA) is one of the rarest congenital anomalies. We report a seven-month-old male with PFAA with upper arch interruption and lower arch coarctation diagnosed by echocardiogram and multidetector computed tomography.

Stripping voltammetric analysis of organophosphate pesticides using Ni/Al layered double hydroxides as solid-phase extraction.

A sensitive electrochemical stripping voltammetric biosensor is designed for organophosphate pesticides (OPs) based on solid-phase extraction (SPE) using Ni/Al layered double hydroxides (LDHs) modified glassy carbon electrode (labeled as Ni/Al-LDHs/GCE). The Ni/Al-LDHs as the host are highly efficient to capture OPs, which dramatically facilitates the enrichment of nitroaromatic OPs onto their surface and realizes the stripping voltammetric detection of OPs. The stripping voltammetric performances of methyl parathion (MP) intercalated into LDHs were evaluated by cyclic voltammetric and square-wave voltammetric (SWV) analysis. The combination of the host-guest supramolecular structure, SPE, and stripping voltammetry provides a fast, simple, and sensitive electrochemical method for detecting nitroaromatic OPs by using MP as a model. The stripping analysis is linear over the MP concentration ranges of 0.001-0.1 and 0.2-1.0 microg mL(-1) with a detection limit of 0.6 ng mL(-1) (S/N=3). The developed biosensor exhibits good reproducibility and acceptable stability. This study offers a new promising protocol for OPs analysis.

Electrochemical biosensing of methyl parathion pesticide based on acetylcholinesterase immobilized onto Au-polypyrrole interlaced network-like nanocomposite.

We developed a simple strategy for designing a highly sensitive electrochemical biosensor for organophosphate pesticides (OPs) based on acetylcholinesterase (AChE) immobilized onto Au nanoparticles-polypyrrole nanowires composite film modifid glassy carbon electrode (labeled as AChE-Au-PPy/GCE). Where, the generated Au nanoparticles (AuNPs) were homogenously distributed onto the interlaced PPy nanowires (PPy NWs) matrix, constructing a three-dimensional porous network. This network-like nanocomposite not only provided a biocompatible microenvironment to keep the bioactivity of AChE, but also exhibited a strong synergetic effect on improving the sensing properties of OPs. The combination of AuNPs and PPyNWs greatly catalyzed the oxidation of the enzymatically generated thiocholine product, thus increasing the detection sensitivity. On the basis of the inhibition of OPs on the enzymatic activity of AChE, the conditions for OPs detection were optimized by using methyl parathion as a model OP compound. The inhibition of methyl parathion was proportional to its concentration ranging from 0.005 to 0.12 and 0.5 to 4.5 microgmL(-1). The detection limit was 2 ngmL(-1). The developed biosensor exhibited good reproducibility and acceptable stability. This study provides a new promise tool for analysis of organophosphate pesticides.

Ascending-to-descending aortic bypass via posterior pericardium for complex coarctation of aorta.

UNLABELLED: We introduce our surgical experience in treating recurrent aortic coarctation or coarctation associated with intracardiac abnormalities, which is difficult to manage. Four patients underwent the operation with hypothermic cardiopulmonary bypass. During the surgery, the posterior pericardium was opened and the thoracic aorta was dissected and sidebiting clamped, and an end-to-side anastomosis of the artificial graft to the descending aorta was performed. The graft was passed in between the inferior vena cava and the inferior right pulmonary vein and posterior to the pericardium. After that, the aorta was clamped and intracardiac repair was finished. Then the proximal artificial graft was anastomosed to the right side of the ascending aorta with heart beating. All patients recovered smoothly. There was no early or late death, without bleeding or other complications after operation. CONCLUSION: "Complex coarctation" can be treated with ascending-to-descending aortic bypass via posterior pericardium and satisfied result can be achieved.

Early and midterm results in anatomic repair of Ebstein anomaly.

OBJECTIVE: We report the results of surgical treatment of Ebstein anomaly during a 10-year period, especially with an anatomic repair technique that restores to near normal anatomic and physiologic function of the tricuspid valve and the right ventricle. METHODS: Between December 1997 and December 2006, 83 consecutive patients aged 9 months to 52 years underwent operation for Ebstein anomaly. Among them, 78 underwent the anatomic repair technique (male 39). Tricuspid incompetence was moderate in 22 patients and severe in 56 patients. The main surgical technique includes excision of the atrialized right ventricle, detachment and repair of the leaflet, transposition of the leaflet, and anulus plication of the tricuspid valve. In some patients in whom the septal leaflet was severely hypoplastic or absent, a new leaflet was created with autologous pericardium. Biventricular repair was not performed in 5 patients with very severely hypoplastic tricuspid valves and poor right ventricular function. RESULTS: All patients survived and recovered uneventfully. For the 78 patients who underwent anatomic repair, postoperative echocardiography showed that tricuspid incompetence disappeared in 65 patients and was mild in 13 patients. Right ventricular function was good. Patients have been doing well during a mean follow-up of 46 months (2 months to 9 years). The latest follow-up echocardiograms showed that tricuspid incompetence was eliminated in 55 patients and was mild in 17, moderate in 3, and severe in 3. The 5 patients with a total cavopulmonary connection procedure and one-and-one-half-ventricle correction procedure are also doing well. CONCLUSIONS: Satisfactory early and midterm results can be achieved with the anatomic repair technique to correct Ebstein anomaly. Tricuspid valve replacement can be avoided in most patients.