Journal Article

Impact of the cone operation on left ventricular size, function, and dyssynchrony in Ebstein anomaly: a cardiovascular magnetic resonance study

Powell, Andrew J., Emani, Sitaram, Rhodes, Jonathan, Fornwalt, Brandon K., Jing, Linyuan, Harrild, David M., Mejia-Spiegeler, Abba, Beroukhim, Rebecca S.

2018

Overview

Background In addition to tricuspid regurgitation (TR) and right ventricular (RV) enlargement, patients with Ebstein anomaly are at risk for left ventricular (LV) dysfunction and dyssynchrony. We studied the impact of the cone tricuspid valve reconstruction operation on LV size, function, and dyssynchrony. Methods All Ebstein anomaly patients who had both pre- and postoperative cardiovascular magnetic resonance (CMR) studies were retrospectively identified. From cine images, RV and LV volumes and ejection fractions (EF) were calculated, and LV circumferential and longitudinal strain were measured by feature tracking. To quantify LV dyssynchrony, temporal offsets (TOs) were computed among segmental circumferential strain versus time curves using cross-correlation analysis and patient-specific reference curves. An LV dyssynchrony index was calculated as the standard deviation of the TOs. Results Twenty patients (65% female) were included with a median age at cone operation of 16 years, and a median time between pre- and postoperative CMR of 2.8 years. Postoperatively, there was a decline in the TR fraction (56 ± 19% vs. 5 ± 4%, p  < 0.001), RV end-diastolic volume (EDV) (242 ± 110 ml/m 2 vs. 137 ± 82 ml/m 2 , p  < 0.001), and RV stroke volume (SV) (101 ± 35 vs. 51 ± 7 ml/m 2 , p  < 0.001). RV EF was unchanged. Conversely, there was an increase in both LV EDV (68 ± 13 vs. 85 ± 13 ml/m 2 , p  < 0.001) and LV stroke volume (37 ± 8 vs. 48 ± 6 ml/m 2 , p  < 0.001). There was no change in LV EF, or global circumferential and longitudinal strain but basal septal circumferential strain improved (16 ± 7% vs. 22 ± 5%, p  = 0.04). LV contraction become more synchronous (dyssynchrony index: 32 ± 17 vs. 21 ± 9 msec, p  = 0.02), and the extent correlated with the reduction in RV EDV and TR. Conclusions In patients with the Ebstein anomaly, the cone operation led to reduced TR and RV stroke volume, increased LV stroke volume, improved LV basal septal strain, and improved LV synchrony. Our data demonstrates that the detrimental effect of the RV on LV function can be mitigated by the cone operation.

• Publisher: BioMed Central,BioMed Central Ltd,Elsevier
• Subject: Adolescent / Adult / Algorithms / Angiology / Cardiac Surgical Procedures / Cardiology / Cardiovascular magnetic resonance / Care and treatment / Child / Child, Preschool / Circumferences / Cone operation / Conization / Contraction / Correlation analysis / Dyssynchrony / Ebstein anomaly / Ebstein Anomaly - diagnostic imaging / Ebstein Anomaly - physiopathology / Ebstein Anomaly - surgery / Ebstein's anomaly / Electrocardiography / Enlargement / Female / Heart / Heart Ventricles - diagnostic imaging / Heart Ventricles - physiopathology / Humans / Imaging / Magnetic resonance / Magnetic resonance imaging / Magnetic Resonance Imaging, Cine / Male / Mathematical analysis / Medicine / Medicine & Public Health / Myocardial Contraction / Offsets / Patients / Predictive Value of Tests / Pulmonary arteries / Radiology / Recovery of Function / Regurgitation / Retrospective Studies / Strain / Stroke volume / Time Factors / Treatment Outcome / Tricuspid valve / Tricuspid Valve - abnormalities / Tricuspid Valve - diagnostic imaging / Tricuspid Valve - physiopathology / Tricuspid Valve - surgery / Ventricle / Ventricular Dysfunction, Left - diagnostic imaging / Ventricular Dysfunction, Left - etiology / Ventricular Dysfunction, Left - physiopathology / Ventricular Function, Left / Ventricular Function, Right / Young Adult