RESUMEN
Tricuspid regurgitation (TR) in children may be secondary to congenital anomalies of the tricuspid valve complex which is composed by annulus, leaflets, commissures, chordae tendineae, and papillary muscles. The most common congenital cause is Ebstein's anomaly; however, there are less frequent causes such as abnormal number of tricuspid leaflets, tricuspid cleft, leaflet prolapse, double orifice tricuspid valve, and congenital tricuspid valve dysplasia. Identifying the precise cause is important to plan an appropriate repair surgery. In this article, the case of a 4-year-old patient with a tetracuspid valve with significant tricuspid regurgitation is presented and the morphological analysis was made by two-dimensional (2D) and three-dimensional (3D) transthoracic echocardiography. The morphological differences between a tetracuspid valve and a cleft of the anterior leaflet tricuspid valve are exposed. 3D echocardiographic evaluation of the tricuspid valve allowed a better understanding of the tricuspid valve anatomy, which includes evaluation of the tricuspid annulus, leaflets, commissures, and subvalvular apparatus. Recognizing the accurate cause of isolated tricuspid regurgitation allows better planning of the surgical technique.
Asunto(s)
Anomalía de Ebstein , Pediatría , Insuficiencia de la Válvula Tricúspide , Humanos , Niño , Preescolar , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/etiología , Ecocardiografía , Válvula Tricúspide/cirugía , Anomalía de Ebstein/complicaciones , Anomalía de Ebstein/cirugíaAsunto(s)
Procedimientos Quirúrgicos Cardíacos , Anomalía de Ebstein , Insuficiencia de la Válvula Tricúspide , Humanos , Anomalía de Ebstein/complicaciones , Anomalía de Ebstein/diagnóstico , Anomalía de Ebstein/cirugía , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/cirugía , Válvula Tricúspide/anomalías , Insuficiencia de la Válvula Tricúspide/diagnóstico , Insuficiencia de la Válvula Tricúspide/etiología , Insuficiencia de la Válvula Tricúspide/cirugíaRESUMEN
Background: Ebstein's anomaly is a rare complex congenital heart disease, first described in 1866 by physician Wilhelm Ebstein, characterized by anatomical and functional malformations of the tricuspid valve and the right ventricle because of inadequate delaminization of the tricuspid valve tissue. By presenting a clinical case and reviewing the literature, we analyzed the approach of an adult patient with Ebstein anomaly with ventricular preexcitation. Clinical case: We describe the case of a 34-year-old male patient, with a clinical history of palpitations and dyspnea, and his paraclinics documented Ebstein type B anomaly associated with patent foramen oval and paroxysmal supraventricular tachycardia, Successful radiofrequency ablation was performed and tricuspid valvuloplasty was proposed. Conclusion: It is concluded that Ebstein's anomaly is complex with clinical, morphological and physiopathological heterogeneous spectrum. Manifested from severe symptomatic forms in the neonatal period to asymptomatic or minimally symptomatic ones detected incidentally. Its diagnosis is based on clinical suspicion and confirmed by echocardiography or imaging studies. The therapeutic strategy may be based on medical management in its mild asymptomatic forms up to surgical interventions that include tricuspid valvuloplasty, palliative surgery, valve replacement or cardiac transplantation.
Introducción: la anomalía de Ebstein es una cardiopatía congénita compleja infrecuente, descrita por primera vez en 1866 por el médico Wilhelm Ebstein, caracterizada por malformaciones anatómicas y funcionales de la válvula tricúspide y del ventrículo derecho a consecuencia de una inadecuada deslaminización del tejido valvular tricuspídeo. Mediante la presentación de caso clínico y revisión de la literatura analizamos el abordaje de un paciente adulto con anomalía de Ebstein con preexcitación ventricular. Caso clínico: describimos el caso de un paciente masculino de 34 años, con historial clínico de palpitaciones y disnea, en sus paraclínicos se documentó anomalía de Ebstein tipo B asociado a foramen oval permeable y taquicardia paroxística supraventricular, como tratamiento se realizó ablación por radiofrecuencia exitosa y proponiéndose valvuloplastia tricuspídea. Conclusión: la anomalía de Ebstein es compleja de espectro clínico, morfológico y fisiopatológico heterogéneo, manifestada desde formas graves sintomáticas en el periodo neonatal hasta asintomáticas o mininamente sintomáticas detectadas de forma incidental. Su diagnóstico parte de la sospecha clínica confirmándose a partir de ecocardiografía o estudios de imagen. La estrategia terapéutica puede estar basada en manejo médico en sus formas leves asintomáticas hasta intervenciones quirúrgicas que incluyen valvulo-plastia tricuspídea, cirugía paliativa, reemplazo valvular o trasplante cardiaco.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Anomalía de Ebstein , Adulto , Anomalía de Ebstein/complicaciones , Anomalía de Ebstein/diagnóstico , Anomalía de Ebstein/cirugía , Ecocardiografía , Humanos , Recién Nacido , MasculinoRESUMEN
BACKGROUND: Accessory pathway (AP)-related arrhythmias are frequent in patients with Ebstein anomaly (EA), and arrhythmia recurrence after catheter ablation remains high despite current technological developments. METHODS: Case series report of patients with EA who were taken to an accessory pathway ablation procedure and where clinical, procedure, and follow-up data are described. In all cases, mapping of the true tricuspid annulus guided by intracardiac ultrasound was used. RESULTS: Six patients with EA underwent an ablation procedure using ICE to delineate the true tricuspid annulus. The duration of the procedure was 253.33 ± 60.92 min, with an acute success of 100%. After a mean follow-up of 16.16 ± 7.7 months, no recurrences of tachycardia were documented, and all patients were free of antiarrhythmic medications. CONCLUSION: Intraprocedural ICE helps to delineate the true tricuspid annulus that contains the APs, facilitating mapping and ablation. We hypothesize that the systematic use of ICE in this scenario improves ablation efficacy while reducing complications, but this must be verified in prospective studies.
Asunto(s)
Fascículo Atrioventricular Accesorio , Ablación por Catéter , Anomalía de Ebstein , Fascículo Atrioventricular Accesorio/diagnóstico por imagen , Fascículo Atrioventricular Accesorio/cirugía , Arritmias Cardíacas/cirugía , Ablación por Catéter/métodos , Anomalía de Ebstein/complicaciones , Anomalía de Ebstein/diagnóstico por imagen , Anomalía de Ebstein/cirugía , Ecocardiografía , Humanos , Estudios ProspectivosRESUMEN
We report an innovative treatment strategy for fetal Ebstein's anomaly with a circular shunt. We used transplacental non-steroidal anti-inflammatory drugs, at the 29th gestational week, to constrict the ductus arteriosus avoiding fetal demise. We addressed the critical neonate with an urgent Starnes procedure. Finally, instead of following the usual single-ventricle palliation pathway after the Starnes procedure, we achieved successful two-ventricle repair with the cone technique at 5 month old.
Asunto(s)
Conducto Arterioso Permeable , Anomalía de Ebstein , Terapias Fetales , Preparaciones Farmacéuticas , Antiinflamatorios no Esteroideos/uso terapéutico , Conducto Arterioso Permeable/tratamiento farmacológico , Anomalía de Ebstein/cirugía , Femenino , Humanos , Lactante , Recién Nacido , EmbarazoRESUMEN
Ventricular tachycardia in Ebstein's anomaly patients is rare and increases the risk of sudden death up to 6 times. We present two cases of Ebstein's anomaly, the first of them with a history of Glenn surgery and biological prosthesis at tricuspid position and the second case without surgical repair. Both admitted to the emergency room due to ventricular tachycardia poorly tolerated. Detailed substrate characterization and pace mapping showed fragmented signals in the area of atrialized right ventricle and correlated were pace mapping reproduced morphology identical to the clinical VT, ablation at this sites were successful without recurrence during follow-up.
Asunto(s)
Ablación por Catéter , Anomalía de Ebstein , Taquicardia Ventricular , Anomalía de Ebstein/complicaciones , Anomalía de Ebstein/cirugía , Electrocardiografía , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/cirugía , Humanos , Taquicardia Ventricular/cirugíaRESUMEN
Although the Cone procedure has improved outcomes for patients with Ebstein´s anomaly (EA), neither RV systolic function recovery in long-term follow-up nor the best echocardiographic parameters to assess RV function are well established. Thus, we evaluated RV performance after the Cone procedure comparing two-dimensional (2DEcho) and three-dimensional (3DEcho) echocardiography to cardiac magnetic resonance (CMR). We assessed 27 EA patients after the Cone procedure (53% female, median age of 20 years at the procedure, median post-operative follow-up duration of 8 years). Echocardiography was performed 4 h apart from the CMR. RV global longitudinal strain (GLS), fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), myocardial performance index and tissue Doppler S' velocity were assessed using 2DEcho, whereas 3DEcho was used to evaluate RV volumes and ejection fraction (RVEF). Echocardiographic variables were compared to CMR-RVEF. All patients were in the NYHA functional class I. Median TAPSE was 15.9 mm, FAC 30.2%, and RV-GLS -15%; median RVEF by 3DEcho was 31.9% and 43% by CMR. Among 2DEcho parameters, RV-GLS and FAC had a substantial correlation with CMR-RVEF (r = - 0.63 and r = 0.55, respectively); from 3DEcho, the indexed RV volumes and RVEF were closely correlated with CMR (RV-EDVi, r = 0.60, RV-ESVi, r = 0.72; and RVEF r = 0.60). RV systolic function is impaired years after the Cone procedure, despite a good clinical status. FAC and RV-GLS are useful 2DEcho tools to assess RV function in these patients; however, 3DEcho measurements appear to provide a better RV assessment.
Asunto(s)
Ecocardiografía Tridimensional/normas , Imagen por Resonancia Cinemagnética/normas , Disfunción Ventricular Derecha/diagnóstico por imagen , Adolescente , Adulto , Niño , Anomalía de Ebstein/cirugía , Ecocardiografía Tridimensional/métodos , Femenino , Humanos , Imagen por Resonancia Cinemagnética/métodos , Masculino , Persona de Mediana Edad , Función Ventricular Derecha , Adulto JovenRESUMEN
Abstract Objective: This study aimed to evaluate Ebstein's anomaly surgical correction and its early and long-term outcomes. Methods: A retrospective analysis of 62 consecutive patients who underwent surgical repair of Ebstein's anomaly in our institution from January 2000 to July 2016. The following long-term outcomes were evaluated: survival, reoperations, tricuspid regurgitation, and postoperative right ventricular dysfunction. Results: Valve repair was performed in 46 (74.2%) patients - 12 of them using the Da Silva cone reconstruction; tricuspid valve replacement was performed in 11 (17.7%) patients; univentricular palliation in one (1.6%) patient; and the one and a half ventricle repair in four (6.5%) patients. The patients' mean age at the time of surgery was 20.5±14.9 years, and 46.8% of them were male. The mean follow-up time was 8.8±6 years. The 30-day mortality rate was 8.06% and the one and 10-year survival rates were 91.9% both. Eleven (17.7%) of the 62 patients required late reoperation due to tricuspid regurgitation, in an average time of 7.1±4.9 years after the first procedure. Conclusion: In our experience, the long-term results of the surgical treatment of Ebstein's anomaly demonstrate an acceptable survival rate and a low incidence of reinterventions.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Válvula Tricúspide/cirugía , Anomalía de Ebstein/cirugía , Complicaciones Posoperatorias/etiología , Reoperación/estadística & datos numéricos , Factores de Tiempo , Insuficiencia de la Válvula Tricúspide/etiología , Índice de Severidad de la Enfermedad , Estudios Retrospectivos , Resultado del Tratamiento , Disfunción Ventricular Derecha/etiología , Anomalía de Ebstein/complicaciones , Anomalía de Ebstein/mortalidad , Estimación de Kaplan-Meier , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/métodos , Procedimientos Quirúrgicos Cardíacos/mortalidadRESUMEN
OBJECTIVE: This study aimed to evaluate Ebstein's anomaly surgical correction and its early and long-term outcomes. METHODS: A retrospective analysis of 62 consecutive patients who underwent surgical repair of Ebstein's anomaly in our institution from January 2000 to July 2016. The following long-term outcomes were evaluated: survival, reoperations, tricuspid regurgitation, and postoperative right ventricular dysfunction. RESULTS: Valve repair was performed in 46 (74.2%) patients - 12 of them using the Da Silva cone reconstruction; tricuspid valve replacement was performed in 11 (17.7%) patients; univentricular palliation in one (1.6%) patient; and the one and a half ventricle repair in four (6.5%) patients. The patients' mean age at the time of surgery was 20.5±14.9 years, and 46.8% of them were male. The mean follow-up time was 8.8±6 years. The 30-day mortality rate was 8.06% and the one and 10-year survival rates were 91.9% both. Eleven (17.7%) of the 62 patients required late reoperation due to tricuspid regurgitation, in an average time of 7.1±4.9 years after the first procedure. CONCLUSION: In our experience, the long-term results of the surgical treatment of Ebstein's anomaly demonstrate an acceptable survival rate and a low incidence of reinterventions.
Asunto(s)
Anomalía de Ebstein/cirugía , Válvula Tricúspide/cirugía , Adolescente , Adulto , Anciano , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/métodos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Niño , Preescolar , Anomalía de Ebstein/complicaciones , Anomalía de Ebstein/mortalidad , Femenino , Humanos , Lactante , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Insuficiencia de la Válvula Tricúspide/etiología , Disfunción Ventricular Derecha/etiología , Adulto JovenRESUMEN
Abstract We presented a 39-year-old female patient with life-threatening hypoxemia after tricuspid valve replacement because of Ebstein's anomaly. And the severe cyanosis is due to bioprosthetic valve stenosis and atrial septal defect. Anesthetic management of a patient with severe obstructive prosthetic valve dysfunction can be challenging. Similar considerations should be given to patients with Ebstein's anomaly to maintain the pressure equalized between the right and left atrial. Transesophageal echocardiography and cerebral oxygen saturation provided real time information in perioperative care.
Resumo Apresentamos o caso de uma paciente de 39 anos, com hipoxemia em risco de vida após a substituição da valva tricúspide devido à anomalia de Ebstein e cianose grave devido à estenose de valva bioprotética e comunicação interatrial. O manejo anestésico de um paciente com disfunção obstrutiva grave de prótese valvar pode ser um desafio. Os pacientes com anomalia de Ebstein também precisam de atenção especial para manter a pressão equalizada entre o átrio direito e o esquerdo. A ecocardiografia transesofágica e a saturação cerebral de oxigênio forneceram informações em tempo real nos cuidados perioperatórios.
Asunto(s)
Humanos , Femenino , Adulto , Estenosis de la Válvula Tricúspide/cirugía , Cianosis/etiología , Anomalía de Ebstein/cirugía , Anestésicos/administración & dosificación , Bioprótesis/efectos adversos , Índice de Severidad de la Enfermedad , Prótesis Valvulares Cardíacas/efectos adversos , Ecocardiografía Transesofágica/métodos , Atención Perioperativa/métodos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Defectos del Tabique Interatrial/cirugía , Hipoxia/etiologíaRESUMEN
Ebstein's anomaly is a congenital heart disease where the most important anatomic feature is the inferior displacement of the tricuspid valve leaflets. Vectorcardiographic features are mainly forgotten and electrocardiographic features may be unrecognized by cardiologists handling adult patients.
Asunto(s)
Anomalía de Ebstein/diagnóstico por imagen , Anomalía de Ebstein/cirugía , Ecocardiografía/métodos , Electrofisiología Cardíaca/métodos , Anomalía de Ebstein/fisiopatología , Electrocardiografía/métodos , Femenino , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/cirugía , Humanos , Recién Nacido , Masculino , Imagen Multimodal/métodos , Sensibilidad y Especificidad , Válvula Tricúspide/anomalías , Válvula Tricúspide/diagnóstico por imagen , Vectorcardiografía/métodosRESUMEN
We presented a 39-year-old female patient with life-threatening hypoxemia after tricuspid valve replacement because of Ebstein's anomaly. And the severe cyanosis is due to bioprosthetic valve stenosis and atrial septal defect. Anesthetic management of a patient with severe obstructive prosthetic valve dysfunction can be challenging. Similar considerations should be given to patients with Ebstein's anomaly to maintain the pressure equalized between the right and left atrial. Transesophageal echocardiography and cerebral oxygen saturation provided real time information in perioperative care.
Asunto(s)
Anestésicos/administración & dosificación , Cianosis/etiología , Anomalía de Ebstein/cirugía , Estenosis de la Válvula Tricúspide/cirugía , Adulto , Bioprótesis/efectos adversos , Ecocardiografía Transesofágica/métodos , Femenino , Defectos del Tabique Interatrial/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Hipoxia/etiología , Atención Perioperativa/métodos , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: Ebstein's anomaly remains a relatively ignored disease. Lying in the 'No Man's land' between congenital and valve surgeons, it largely remains inadequately studied. We report our short-term results of treating it as a 'one and a half ventricle heart' and propose that the true tricuspid annulus (TTA) 'Z' score be used as an objective criterion for estimation of 'functional' right ventricle (RV). METHODS: 22 consecutive patients undergoing surgery for Ebstein's anomaly were studied. Echocardiography was performed to assess the type and severity of the disease, tricuspid annular dimension and its 'Z' score. Patients were operated by a modification of the cone repair, with addition of annuloplasty, bidirectional cavopulmonary shunt (BCPS) and right reduction atrioplasty to provide a comprehensive repair. TTA 'Z' score was correlated later with postplication indexed residual RV volume. RESULTS: There was one (4.5%) early and no late postoperative death. There was a significant reduction in tricuspid regurgitation grading (3.40±0.65 to 1.22±0.42, P<0.001). Residual RV volume reduced to 71.96±3.8% of the expected volume and there was a significant negative correlation (rho -0.83) between TTA 'Z' score and indexed residual RV volume. During the follow-up of 20.54±7.62 months, the functional class improved from 2.59±0.7 to 1.34±0.52 (P<0.001). CONCLUSION: In Ebstein's anomaly, a higher TTA 'Z' score correlates with a lower postplication indexed residual RV volume. Hence, a complete trileaflet repair with offloading of RV by BCPS (when the TTA 'Z' score is >2) is recommended. The short-term outcomes of our technique are promising.
Asunto(s)
Anuloplastia de la Válvula Cardíaca/métodos , Anomalía de Ebstein/cirugía , Procedimiento de Fontan/métodos , Ventrículos Cardíacos/cirugía , Válvula Tricúspide/cirugía , Adolescente , Adulto , Anuloplastia de la Válvula Cardíaca/mortalidad , Niño , Preescolar , Anomalía de Ebstein/diagnóstico por imagen , Anomalía de Ebstein/mortalidad , Ecocardiografía , Femenino , Estudios de Seguimiento , Procedimiento de Fontan/mortalidad , Ventrículos Cardíacos/fisiopatología , Humanos , Lactante , Masculino , Ilustración Médica , Complicaciones Posoperatorias , Recuperación de la Función , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Válvula Tricúspide/diagnóstico por imagen , Adulto JovenRESUMEN
Abstract Objective: Ebstein's anomaly remains a relatively ignored disease. Lying in the 'No Man's land' between congenital and valve surgeons, it largely remains inadequately studied. We report our short-term results of treating it as a 'one and a half ventricle heart' and propose that the true tricuspid annulus (TTA) 'Z' score be used as an objective criterion for estimation of 'functional' right ventricle (RV). Methods: 22 consecutive patients undergoing surgery for Ebstein's anomaly were studied. Echocardiography was performed to assess the type and severity of the disease, tricuspid annular dimension and its 'Z' score. Patients were operated by a modification of the cone repair, with addition of annuloplasty, bidirectional cavopulmonary shunt (BCPS) and right reduction atrioplasty to provide a comprehensive repair. TTA 'Z' score was correlated later with postplication indexed residual RV volume. Results: There was one (4.5%) early and no late postoperative death. There was a significant reduction in tricuspid regurgitation grading (3.40±0.65 to 1.22±0.42, P<0.001). Residual RV volume reduced to 71.96±3.8% of the expected volume and there was a significant negative correlation (rho −0.83) between TTA 'Z' score and indexed residual RV volume. During the follow-up of 20.54±7.62 months, the functional class improved from 2.59±0.7 to 1.34±0.52 (P<0.001). Conclusion: In Ebstein's anomaly, a higher TTA 'Z' score correlates with a lower postplication indexed residual RV volume. Hence, a complete trileaflet repair with offloading of RV by BCPS (when the TTA 'Z' score is >2) is recommended. The short-term outcomes of our technique are promising.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto , Adulto Joven , Válvula Tricúspide/cirugía , Procedimiento de Fontan/métodos , Anomalía de Ebstein/cirugía , Anuloplastia de la Válvula Cardíaca/métodos , Ventrículos Cardíacos/cirugía , Complicaciones Posoperatorias , Válvula Tricúspide/diagnóstico por imagen , Ecocardiografía , Estudios de Seguimiento , Procedimiento de Fontan/mortalidad , Recuperación de la Función , Anomalía de Ebstein/mortalidad , Anomalía de Ebstein/diagnóstico por imagen , Anuloplastia de la Válvula Cardíaca/mortalidad , Ventrículos Cardíacos/fisiopatología , Ilustración MédicaRESUMEN
Introducción: la anomalía de Ebstein es una rara malformación congénita cardiaca, definida por un desplazamiento apical de las valvas septal y posterior de la válvula tricúspide hacia el interior del ventrículo derecho, en vez de hacerlo a nivel del anillo auriculoventricular, lo cual conlleva un aumento del volumen de la aurícula derecha (megaurícula) a expensas de una reducción del tamaño del ventrículo del mismo lado (auriculización del ventrículo). Causa una significante regurgitación tricuspídea y reducción de la capacidad funcional del ventrículo, dilatación atrioventricular derecha, con arritmias auriculares y ventriculares, las que tienden a hacerse resistentes en ocasiones, o de difícil tratamiento. El desplazamiento del orificio valvular tricuspídeo produce una división del ventrículo derecho en una porción integrada al atrio derecho, lo que constituye la porción atrializada del ventrículo derecho, en tanto la porción apicotrabecular y de salida constituye su parte funcional. Objetivo: presentar la evolución clínico-anestesiológica de una paciente con anomalía de Ebstein. Caso clínico: paciente de 69 años de edad programada para cirugía electiva en dos ocasiones por diferentes enfermedades oncológicas, portadora de anomalía de Ebstein. Antecedentes de tromboembolismo pulmonar, tres cirugías cardiacas, diabetes mellitus e hipertensión arterial, enfermedad arterial aterosclerótica estable e infarto cerebral media derecha embólico. Se evitaron aquellas condiciones que aumenten el trabajo cardiaco y el consumo de oxígeno. Conclusiones: el desafío que representa para el anestesiólogo, aquellos pacientes que sufren anomalía de Ebstein puede variar de paciente a paciente, en dependencia del estado físico, el tipo de enfermedad y las técnicas de monitorización(AU)
Introduction: Ebstein's anomaly is a rare congenital cardiac malformation, defined by an apical displacement of the septal and posterior leaflets of the tricuspid valve into the right ventricle, instead of at the level of the atrioventricular ring, which leads to an increase of the volume of the right atrium (mega atrium) at the expense of a size reduction for the ventricle on the same side (auriculization of the ventricle). It causes a significant tricuspid regurgitation and reduction of the functional capacity of the ventricle, right atrioventricular dilation, with atrial and ventricular arrhythmias, which tend to become resistant at times, or difficult to treat. The displacement of the tricuspid valve orifice produces a division of the right ventricle in a portion integrated to the right atrium, which constitutes the atrialized portion of the right ventricle, while the apico-trabecular and exit portion constitutes its functional part. Objective: To present the clinical-anesthesiological evolution of a patient with Ebstein's anomaly. Clinical case: A 69-year-old patient, with Ebstein's anomaly, who was scheduled for elective surgery on two occasions for different oncological diseases. History of pulmonary thromboembolism, three cardiac surgeries, diabetes mellitus and arterial hypertension, stable atherosclerotic arterial disease, and right middle cerebral infarction. Conditions that increase cardiac work and oxygen consumption were avoided. Conclusions: The challenge patients suffering from Ebstein's anomaly represent for the anesthesiologist can vary from patient to patient, depending on the physical state, the type of disease, and the monitoring techniques(AU)
Asunto(s)
Humanos , Femenino , Anciano , Anomalía de Ebstein/cirugía , Anestesia en Procedimientos Quirúrgicos Cardíacos/métodos , Gasto Cardíaco Elevado/prevención & controlRESUMEN
A passagem do cabo-eletrodo ventricular pela valva tricúspide pode ser um problema em pacientes com anomalia de Ebstein recém-operados. Neste trabalho, em que analisamos os prontuários de 3 pacientes, entre 1998 e 2012, são apresentadas alternativas de implante de marcapasso definitivo nesses casos. A estimulação cardíaca artificial preservando a valva tricúspide na anomalia de Ebstein corrigida pode ser feita de maneira eficaz pelas técnicas apresentadas
Passing the ventricular lead through the tricuspid valve may be a problem in patients recently operated for Ebstein's anomaly. In this study, which evaluated hospital charts of 3 patients from 1998 to 2012 we report alternatives for definitive pacemaker implantation. Artificial cardiac pacing preserving the tricuspid valve in corrected Ebstein anomaly may be performed effectively using the described techniques