More than valve repair: Effect of cone reconstruction on right ventricular geometry and function in patients with Ebstein anomaly

Background Cone reconstruction is a novel surgical procedure for tricuspid valve repair in Ebstein anomaly. This study examined the effect of cone reconstruction on right ventricle (RV) geometry, function, and synchronization. Methods Twenty-one patients (4-49 year-old) underwent cone reconstruction were enrolled, and matched with healthy individuals. Pre-operative and follow-up echocardiography was performed along with cardiac magnetic resonance (CMR) imaging in 18 patients. A new parameter, tricuspid annular movement synchronicity index (TAMSI), was used to describe global synchronization of RV in the annular plane. TAMSI was defined as standard deviation of the systolic excursion of the hinge points of the three leaflets divided by their average value. Results After 9.1 (range 1-12) months follow-up, there were no deaths; tricuspid regurgitation was reduced from moderate/severe to mild or less in 95.2% of patients. In 18 patients with both pre and post CMR data, functional RV volume decreased after repair (134.3 ± 58.3 ml/m² to 96.6 ± 29.6 ml/m²; P = 0.001), while ejection fraction was not significantly altered (38.2 ± 9.2% to 36.5 ± 8.5%; P = 0.357). TAMSI was significantly reduced after surgery, from 0.613 ± 0.220 to 0.169 ± 0.088 (P < 0.001). A value similar to the normal control (0.181 ± 0.081) indicated more synchronized RV movement pattern. Conclusions Cone reconstruction yielded good short-term survival in Ebstein anomaly. It reduced functional RV volume, improved RV global synchronization, and restored RV geometry. As such, it may improve RV performance and long-term prognosis. In addition, our described TAMSI proved to be a useful adjunct to postoperative assessments.