Journal of Perioperative Echocardiography

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VOLUME 6 , ISSUE 1 ( June, 2018 ) > List of Articles

REVIEW ARTICLE

Role of Comprehensive Perioperative Transesophageal Echocardiography in Ebstein\'s Anomaly

Usha Kiran, Neeti Makhija, Ira Balakrishnan, Ummed Singh

Keywords : Ebstein\'s anomaly, Perioperative, Transesophageal echocardiography

Citation Information : Kiran U, Makhija N, Balakrishnan I, Singh U. Role of Comprehensive Perioperative Transesophageal Echocardiography in Ebstein\'s Anomaly. J Perioper Echocardiogr 2018; 6 (1):3-9.

DOI: 10.5005/jp-journals-10034-1078

License: CC BY-SA 4.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2018 Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Ebstein\'s anomaly (EA) is a complex congenital anomaly with a broad morphological spectrum. Although typically characterized by apical displacement of the septal tricuspid leaflet (STL) .8 mm/m2 body surface area (BSA), diagnostic categorization is confusing in cases with minor downward displacement of the leaflets. A comprehensive transesophageal echocardiography (TEE) has an integral role in the surgical decision-making and perioperative management of EA. Preoperative TEE aims to provide the morphological diagnosis, coexistent cardiac lesions most commonly, atrial septal defect (ASD), degree of atrialization of the right ventricle (RV), size of the functional RV, biventricular function, quantification of the resultant tricuspid regurgitation (TR), and the amenability of the leaflets to surgical repair. Postoperatively, TEE examination can elucidate valuable information about the competency of tricuspid apparatus, RV dysfunction, and any residual shunting across ASD. Threedimensional echocardiography has been especially employed to study the leaflet morphology and coaptation defects. The TEE is also indispensable in guiding the management of critically sick neonates with EA. The Great Ormond Street Echocardiography (GOSE) score predicts mortality in neonatal EA and has been proposed for risk stratification. The TEE is also helpful in identifying the cases which are not suitable for a biventricular repair and the ones which may require a valve replacement.


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  1. Attenhofer Jost CH, Connolly HM, Dearani JA, Edwards WD, Danielson GK. Ebstein's anomaly. Circulation 2007 Jan;115(2): 277-285.
  2. Anderson KR, Lie JT. The right ventricular myocardium in Ebstein's anomaly: a morphometric histopathologic study. Mayo Clin Proc 1979 Mar;54(3):181-184.
  3. Seward JB. Ebstein's anomaly: ultrasound imaging and hemodynamic evaluation. Echocardiography 1993 Nov;10(6): 641-664.
  4. Huttin O, Voilliot D, Mandry D, Venner C, Juillière Y, Selton- Suty C. All you need to know about the tricuspid valve: tricuspid valve imaging and tricuspid regurgitation analysis. Arch Cardiovasc Dis 2016 Jan;109(1):67-80.
  5. Gatzoulis, MA.; Webb, GD.; Daubeney, PE. Diagnosis and management of adult congenital heart disease. 3rd ed. Philadelphia (PA): Elsevier; 2018. p. 66.
  6. Eidem BW, Tei C, O'Leary PW, Cetta F, Seward JB. Nongeometric quantitative assessment of right and left ventricular function: myocardial performance index in normal children and patients with Ebstein anomaly. J Am Soc Echocardiogr 1998 Sep;11(9):849 -856.
  7. Watson H. Natural history of Ebstein's anomaly of the tricuspid valve in childhood and adolescence: an international cooperative study of 505 cases. Br Heart J 1974 May;36(5):417-427.
  8. Carpentier A, Chauvaud S, Mace L, Relland J, Mihaileanu S, Marino JP, Abry B, Guibourt P. A new reconstructive operation for Ebstein's anomaly of the tricuspid valve. J Thorac Cardiovasc Surg 1988 Jul;96(1):92-101.
  9. Dearani JA, Bacha E, da Silva JP. Cone reconstruction of the tricuspid valve for Ebstein's anomaly: anatomic repair. Oper Tech Thorac Cardiovasc Surg 2008 Summer;13(2):109-125.
  10. Bharucha T, Anderson RH, Lim ZS, Vettukattil JJ. Multiplane review of three-dimensional echocardiography gives new insights into the morphology of Ebstein's malformation. Cardiol Young 2010 Feb;20(1):49-53.
  11. Vettukattil JJ, Bharucha T, Anderson RH. Defining Ebstein's malformation using three dimensional echocardiography. Interact Cardiovasc Thorac Surg 2007 Dec;6(6):685-690.
  12. Celermajer DS, Cullen S, Sullivan ID, Spiegelhalter DJ, Wyse RK, Deanfield JE. Outcome in neonates with Ebstein's anomaly. J Am Coll Cardiol 1992 Apr;19(5):1041-1046.
  13. Jaquiss RD, Imamura M. Management of Ebstein's anomaly and pure tricuspid insuffciency in the neonate. Semin Thorac Cardiovasc Surg 2007Autumn;19(3):258-263.
  14. Quinonez LG, Dearani JA, Puga FJ, O'Leary PW, Driscoll DJ, Connolly HM, Danielson GK. Results of the 1.5-ventricle repair for Ebstein anomaly and the failing right ventricle. J Thorac Cardiovasc Surg 2007 May;133(5):1303-1310.
  15. Raju VK, Dearani JA, Burkhart HM, Grogan M, Phillips SD, Ammash N, Pike RP, Johnson JN, O'Leary PW. Right ventricular unloading for heart failure related to Ebstein malformation. Ann Thorac Surg 2014 Jul;98(1):167-174.
  16. Dearani JA, Oleary PW, Danielson GK. Surgical treatment of Ebstein's malformation: state of the art in 2006. Cardiol Young 2006 Sep;16(Suppl 3):12-20.
  17. Reemtsen BL, Fagan BT, Wells WJ, Starnes VA. Current surgical therapy for Ebstein anomaly in neonates. J Thorac Cardiovasc Surg 2006 Dec;132(6):1285-1290.
  18. Reemtsen BL, Polimenakos AC, Fagan BT, Wells WJ, Starnes VA. Fate of the right ventricle after fenestrated right ventricular exclusion for severe neonatal Ebstein anomaly. J Thorac Cardiovasc Surg 2007 Dec;134(6):1406-1410, discussion 1410-1412.
  19. Reemtsen BL, Starnes VA. Fenestrated right ventricular exclusion (Starnes' procedure) for severe neonatal Ebstein's anomaly. Oper Tech Thorac Cardiovasc Surg 2008 Summer; 13(2):91-100.
  20. Starnes VA, Pitlick PT, Bernstein D, Griffin ML, Choy M, Shumway NE. Ebstein's anomaly appearing in the neonate. A new surgical approach. J Thorac Cardiovasc Surg 1991 Jun;101(6):1082-1087.
  21. Danielson GK, Driscol l DJ, Mair DD, Warnes CA, Oliver WC Jr. Operative treatment of Ebstein's anomaly. J Thorac Cardiovasc Surg 1992 Nov;104(5):1195-1202.
  22. Brown ML, Dearani JA, Danielson GK, Cetta F, Connolly HM, Warnes CA, Li Z, Hodge DO, Driscoll DJ. Functional status after operation for Ebstein anomaly: the Mayo Clinic experience. J Am Coll Cardiol 2008 Aug;52(6):460-466.
  23. Tang XJ, Bao M, Zhao H, Wang LY, Wu QY. Intraoperative transesophageal echocardiography in the operation of Ebstein's anomaly: a retrospective study. Chin Med J (Engl) 2017 Jul;130(3):1540-1543.
  24. Planinc I, Baricevic Z, Reskovic Luksic V, Lovric D, Veceric S, Hanezevacki JS. Three dimensional echocardiography in classification of Ebsteins anomaly: a case report on agenesis of the tricuspid valve posterior leaflet. Cardiologia Croatica 2013 May/Jun;8(5-6):201-202.
  25. van Noord PT, Scohy TV, McGhie J, Bogers AJ. Three-dimensional transesophageal echocardiography in Ebstein's anomaly. Interact Cardiovasc Thorac Surg 2010 May;10(5):836-837.
  26. Schwitz F, Wenaweser P, Kadner A, Wustmann K, Windecker S, Schwerzmann M.. A valve in valve approach for Ebstein's anomaly. Cardiovasc Med 2015 Apr;18(4):139-141.
  27. Ammash NM, Warnes CA, Connolly HM, Danielson GK, Seward JB. Mimics of Ebstein's anomaly. Am Heart J 1997 Sep;134(3):508-513.
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