Cone Reconstruction for Ebstein’s Anomaly: Late Biventricular Function and Possible Remodeling

ABSTRACT Objectives To evaluate late-term tricuspid valve competence and biventricular function following cone reconstruction for Ebstein’s anomaly, and to explore biventricular remodeling. Methods Consecutive adult and pediatric patients who underwent cone reconstruction from 2009 to 2019 were reviewed for inclusion in this retrospective cardiac magnetic resonance imaging (CMR) study. Tricuspid valve competence was assessed with tricuspid regurgitation fraction (TR). Biventricular systolic function was assessed by ejection fraction (EF), cardiac index (CI), indexed stroke volume (SV), and indexed aortic and pulmonary artery beat volume. Biventricular remodeling was assessed by planimetered areas (RA, functional RV, left heart), and indexed end-diastolic (EDVi) and end-systolic (ESVi) ventricular volumes. Paired T-tests or Wilcoxon signed-rank tests were used for analyses. Results Of 58 included patients, 50 underwent CMR. Twelve patients had both preoperative and late postoperative CMR with a median follow-up of 5.11 [3.12 – 6.07] years. Focusing on these, TR decreased (69 to 10%, p=0.014), RV-EF remained stable, and antegrade pulmonary artery beat volume increased (26.7 to 41.6 mL/beat/m2, p=0.037). The LV-SV (30.4 to 44.1 mL/m2, p=0.015) and antegrade aortic beat volume (28.5 to 41.1 mL/beat/m2, p=0.014) also increased, and the LV-SV improved progressively with time since surgery (p=0.048). While the RA area decreased (p=0.004), the functional RV and left heart area increased (cm2, p=0.021, p=0.004). RV volumes showed a tendency to normalize and LV-EDVi increased (50 to 69 mL/m2, p=0.03) over time. Conclusions Cone valve integrity was sustained. Biventricular function improved progressively during follow-up, and there are positive signs of biventricular remodeling late after cone reconstruction.