Tricuspid valve surgery improves cardiac output and exercise performance in patients with Ebstein's anomaly

Andreas Kühn, Gabriella De Pasquale Meyer, Jan Müller, Kurt Petzuch, Sohrab Fratz, Christoph Röhlig, Alfred Hager, Christian Schreiber, John Hess, Manfred Vogt

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Background: Clinical, hemodynamic and functional effects of tricuspid valve surgery in patients with Ebstein's anomaly are not well understood. Methods: Sixteen patients (median age of 27.7 years) were examined before and eight months after surgery by means of echocardiography, cardiovascular magnetic resonance (CMR) and cardiopulmonary exercise testing. Results: Peak work load (1.87 to 2.0 W/kg; p = 0.026), maximum oxygen uptake (21 to 22 ml/kg/min; p = 0.034) as well as cardiac output (2.7 to 2.9 l/min/m2; p = 0.035) increased postoperatively. The reduction of tricuspid regurgitation led to a higher pulmonary stroke volume (29 to 42 ml/m2, p = 0.005) and augmented the left ventricular (LV) volume (55 to 63 ml/min/m2; p = 0.001) with a trend to better ejection fraction (61 to 64%; p = 0.083). Right ventricular (RV) volume index (124 to 108 ml/m2; p = 0.034) and ejection fraction (50 to 42%; p = 0.036) decreased on CMR. Echocardiographic measurements of RV function also decreased (tricuspid annular plane systolic excursion 2.3 to 1.7; p = 0.002; isovolumic acceleration 0.98 to 0.65; p = 0.004; and 2-d longitudinal global strain - 19.3 to - 16.25; p = 0.006). Conclusion: Tricuspid valve surgery improves exercise capacity in patients with Ebstein's anomaly. The reduction of tricuspid regurgitation decreases the volume of the right ventricle and increases pulmonary antegrade flow. As a result LV volume and cardiac output increase. This hemodynamic benefit occurs despite the preload dependent reduction in RV volume and ejection fraction.

Original languageEnglish
Pages (from-to)494-498
Number of pages5
JournalInternational Journal of Cardiology
Issue number2
StatePublished - 20 Jun 2013


  • Cardiopulmonary exercise test
  • Cardiovascular magnetic resonance
  • Ebstein's anomaly
  • Echocardiography
  • Surgery


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