ABSTRACT
BACKGROUND: Ebstein anomaly is a rare congenital anomaly of the tricuspid valve which presents challenges to cardiac surgeons due to the spectrum of the disease and the technical difficulty of valve repair. The natural history of the anomaly differs between patients presenting in the neonatal period to those presenting in adulthood. METHODS: A retrospective review of all patients >15 years of age with Ebstein anomaly, undergoing surgery on the tricuspid valve at 6 centers across Australia and New Zealand was performed. Patients from 1985 to 2019 were included in the study. RESULTS: A total of 125 patients were included in the study, 76 patients (60%) undergoing tricuspid valve repair, of which 23 patients underwent a Cone repair and 49 (40%) had a tricuspid valve replacement. The mean follow-up was 7.9 ± 7.3 years. Postoperatively, early mortality was 3 patients (2%) and 10-year survival was 91.5%. A postoperative pacemaker was required in 24 patients (19%). Reoperation was required in 21 patients (17%). There was no statistically significant difference in survival or reoperation between patients who underwent repair or replacement of the tricuspid valve; however, with a small number of patients in long-term follow-up. CONCLUSION: Older children and adult patients undergoing surgery for Ebstein anomaly in Australia and New Zealand experience good medium-term postoperative survival. Repair of the valve is achieved in a significant proportion of patients with increasing use and success with the Cone repair technique.
Subject(s)
Ebstein Anomaly , Child , Infant, Newborn , Adult , Humans , Adolescent , Ebstein Anomaly/surgery , New Zealand , Treatment Outcome , Tricuspid Valve/surgery , AustraliaABSTRACT
In our series of over 60 dacryocystograms using the digital subtraction technique we report on two cases in which this examination was done postoperatively. The fine, detailed presentation of the topography showed that the dacryorhinostomy was functionally open in spite of the suspicion of clinical failure. In the second case, the fine fistulas between the nasolacrimal duct and maxillary sinus could only be demonstrated by the subtraction study. A conventional dacryocystogram failed to show this important detail. The time necessary for both examination techniques is about equal. Digital subtraction dacryocystography has the advantages of immediate availability, the capacity to observe the flow of the contrast medium kinetically and a superior topography display. It is therefore ideal for the evaluation of postoperative topography after lacrimal and sinus surgery.
