Repair of Ebstein anomaly: early and mid-term results.

BACKGROUND: Ebstein anomaly is the downward displacement and adherence of dysplastic septal and posterior tricuspid leaflets into the right ventricle, thereby dividing the ventricle into a so-called atrialized chamber and a functionally reduced right ventricle. We evaluated the early and mid-term results of primary repair of Ebstein anomaly in adult patients. METHODS: Eight consecutive patients undergoing repair of Ebstein anomaly with Danielson technique at Imam Khomeini Medical Center, Tehran, Iran from January 1997 through July 2004 were evaluated. Functional and echocardiographic parameters were studied both preoperatively and postoperatively, as well as demographic status and adverse events. RESULTS: Hospital mortality occurred in one patient because of right ventricular failure. The average follow-up period was 5.3 +/- 3.4 years (median: 3.8 years). The actuarial survival rate was 85.7 +/- 4.8% at 7 years. During the follow-up, six patients were in New York Heart Association functional class I, and one patient was in class II. None of the patients required reoperation related to their Ebstein repair. One patient demonstrated atrioventricular dissociation perioperatively; however, only one patient required permanent pacemaker insertion later. One patient had minimal (1+) regurgitation, with the jet localized along the anterior part of the ventricular septum. Two patients had residual tricuspid valve insufficiency (2+) on echocardiography. CONCLUSION: Ebstein repair has a good functional and hemodynamic outcome in adult patients.

Results of the repair of aortic false aneurysm.

Aortic false aneurysm is a rare complication of surgery of the aorta that can occur several months to years after the initial operation. We reviewed our results with false aneurysm repair using deep hypothermia and circulatory arrest. Three patients were reoperated for false aneurysm of the ascending aorta. Femorofemoral cardiopulmonary bypass with a heparinized system was used in all patients. Hypothermic circulatory arrest at an average temperature of 20 degrees C was instituted in all patients for repair. Two patients had a patch repair with pericardium, and the other one had primary repair of the defect. All patients had false aneurysms in the ascending aorta at the site of a previous aortotomy. Two patients had proven infection as the cause. The mean cardiopulmonary bypass time was 183 +/- 20 minutes, and the mean circulatory arrest time was 35 minutes. Operative mortality was not seen. The mean time for extubation in survivors was 10 - 12 hours, and the average time to discharge was 26 days. Aortic false aneurysms can be safely approached using femorofemoral cardiopulmonary bypass, hypothermic circulatory arrest, and patch repair with acceptable operative mortality and long-term survival.