560Postoperative left ventricular diastolic dysfunction in adults with Ebstein's anomaly


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Abstract

Purpose: There has been no detailed study about the left ventricular (LV) function after surgery in adults with Ebstein's anomaly. Studies in children with Ebstein's anomaly have suggested a possibility of persistent LV diastolic dysfunction. The aim of this study was to evaluate the pre- and post-operative LV function in adults with Ebstein's anomaly.Methods: Twenty adults with Ebstein's anomaly underwent tricuspid valve repair or replacement (9 repair, 11 replacement). Biventricular functions were studied by using Doppler echocardiography before and after surgery. Preoperatively, all of them showed severe tricuspid regurgitation and preserved LV systolic function. Fourteen age-matched adults with atrial septal defect (ASD) were assessed before and after ASD closure as a control group.Results: Ebstein's anomaly group showed a significant increase post-operative LV E/e' compared to pre-operative one (4.75 +/- 2.3 vs 7.85 +/- 3.9, p< 0.01), while there was no change in ASD group. Pre-operative LV E/e' was lower in Ebstein's anomaly group than that in ASD group (4.75 +/- 2.3 vs 5.2 +/- 2.0, p<0.05). On the other hand, post-operative LV E/e' was significantly higher in Ebstein's anomaly group than that in ASD group (7.85 +/- 3.9 vs 5.5 +/- 2.6, p<0.01). None in preoperative Ebstein's anomaly group or ASD group showed LV E/''>15 suggesting high LV filling pressure, although, 3 patients in postoperative Ebstein's anomaly group showed LV E/e'>15. Between Ebstein's anomaly group and ASD group, there were no significant differences in preoperative and postoperative LVEDV, LVESV, LVEF, cardiac output, MAPSE, LV Tissue Doppler S wave, left atrial dimension, E/A, and right ventricular inlet dimension. All 34 cases showed septal reversed motion.Conclusion: LV diastolic dysfunction presents in adults with Ebstein's anomaly after tricuspid valve repair or replacement. This suggests that congenital pathological change of the LV in Ebstein's anomaly is concealed due to the LV underfilling.

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