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CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Functional Status After Operation for Ebstein Anomaly

The Mayo Clinic Experience

Morgan L. Brown, MD^_*, Joseph A. Dearani, MD, FACC^_*, Gordon K. Danielson, MD, FACC^_*, Frank Cetta, MD, FACC^,, Heidi M. Connolly, MD, FACC, Carole A. Warnes, MD, FACC^,, Zhuo Li, MS, David O. Hodge, MS and David J. Driscoll, MD, FACC^,_*

^_* Division of Cardiovascular Surgery, Mayo Clinic Center Congenital Heart Center, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota
Division of Pediatric Cardiology, Mayo Clinic Center Congenital Heart Center, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota
Division of Cardiovascular Diseases, Mayo Clinic Center Congenital Heart Center, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota
Division of Biostatistics, Mayo Clinic Center Congenital Heart Center, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota.

Manuscript received January 22, 2008; revised manuscript received February 25, 2008, accepted March 3, 2008.

^_* Reprint requests and correspondence: Dr. David J. Driscoll, Mayo Clinic, 200 1st Street SW, Rochester, Minnesota 55905. (Email: driscoll.david{at}mayo.edu).

Objectives: The objective of this study was to review the long-term functional outcome of patients with Ebstein anomaly who had cardiac operation at our institution.

Background: Ebstein anomaly is a spectrum of tricuspid valvular and right ventricular dysplasia. Many patients will require operation in an attempt to improve quality of life.

Methods: From April 1, 1972, to January 1, 2006, 539 patients with Ebstein anomaly underwent 604 cardiac operations at the Mayo Clinic in Rochester, Minnesota. Patient records were reviewed, and all patients known to still be alive were mailed a medical questionnaire or contacted by telephone.

Results: At the initial operation at our institution, the mean age of the patients was 24 years (range 8 days to 79 years) and 53% were female patients. Survival at 5, 10, 15, and 20 years was 94%, 90%, 86%, and 76%, respectively. Survival free of late reoperation was 86%, 74%, 62%, and 46% at 5, 10, 15, and 20 years, respectively. Surveys were returned by 285 of 448 (64%) patients known to be alive at the time of this study. Two hundred thirty-seven (83%) patients were in New York Heart Association functional class I or II, and 34% were taking no cardiac medication. One hundred three patients (36%) reported an incident of atrial fibrillation or flutter, 5 patients (2%) reported having had endocarditis, and 1 patient (<1%) reported having a stroke. There were 275 pregnancies among 82 women. The recurrence of congenital heart disease was reported in 9 of 232 (3.9%) liveborn children.

Conclusions: Patients have good long-term survival and functional outcomes after undergoing surgery for Ebstein anomaly. Atrial arrhythmias are common both before and after surgery. Many patients have had one or more successful pregnancies with a low-recurrence risk of congenital heart disease.

Key Words: valves • surgery • heart defects congenital • Ebstein anomaly

Abbreviations and Acronyms   ASD = atrial septal defect   LV = left ventricle/ventricular   NYHA = New York Heart Association   RV = right ventricle/ventricular   TV = tricuspid valve

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