학술대회 안내 사전등록 안내 초록등록 안내 초록등록/관리 숙박및교통 안내


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Modified Hetzer technique for surgical correction of Ebstein's anomaly
서울 아산 병원 소아 심장외과¹ , 소아 심장과²
윤태진¹, 임유미¹ 정성호¹ 박정준¹ 서동만¹ 장원경² 김영휘² 박인숙² 고재곤²
Objective: Hetzer procedure for the correction of Ebstein’s anomaly has advantages of technical feasibility, incorporation of atrialized right ventricle(RV) into functional RV, and uniform excellent results in the literature. We have elected to employ this technique in recent series of Ebstein’s anomaly when tricuspid valve is deemed repairable. Methods: A retrospective review of 10 patients with Ebstein’s anomaly, who underwent tricuspid valve repair by Hetzer technique between March 2002 and June 2006, was performed. Results: Median age at operation was 18.6 years (6 months - 65 years). There were 4 males and 6 females. Carpentier types were A in 6, B in 2 and C in 2. All patients showed severe tricuspid regurgitation (TR) preoperatively, and arterial desaturation (< 95%) was present in 3 patients. Original Hetzer technique was employed in 6 patients with type A anomaly. In the remaining 4 patients with type B or C anomalies, valve competence was restored at the level of displaced tricuspid valve mechanism by placing a stitch between true annulus and ventricular mid-septum near the displaced septal leaflet. Concomitant arrhythmia surgery was performed in 4 patients: cavo-tricuspid isthmus cryablation for atrial flutter (2), right side maze operation for atrial fibrillation (1), and extranodal cryablation for atrioventricular node re-entry tachycardia (1). Bidirectional cavo-pulmonary shunt was added in all patients. Median follow-up was 8.2 months (2.2-51.9). There was no early or late death, and immediate postoperative TR was trivial to mild in 8 patients. Median preoperative and immediate postoperative TR jet areas in 6 adult patients were 21 cm² and 6.5 cm², respectively. Median cardio-thoracic ratios on chest X ray at preoperative and postoperative 0, 1, 6 months were 66%, 63%, 57% and 55%, respectively. Conclusion: Hetzer technique is useful for the correction of Ebstein’s anomaly.


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