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Cardiac remodeling after tricuspid valve repair in Ebstein’s anomaly: a magnetic resonance study

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Abstract

Objectives

We aimed to evaluate immediate and midterm cardiac remodeling after surgery by cardiac magnetic resonance (CMR) in Ebstein’s anomaly (EA), and also to investigate preoperative predictors of right ventricular (RV) normalization.

Methods

We retrospectively analyzed CMR parameters of the whole heart in adult patients with EA before surgery, at discharge and follow-up.

Results

A total of 26 patients were included and performed CMR at 7 days (interquartile range, 3–13 days) before surgery. Immediate postoperative CMR was finished at discharge (median: 8 [7–9] days; n = 18) and follow-up CMR at 187 days (interquartile range, 167–356 days; n = 17). RV and right atrial (RA) volumes promptly decreased immediately after surgery and at follow-up (all p < 0.05). RV ejection fraction decreased significantly at discharge (p < 0.05) but recovered at follow-up (p = 0.18). However, RV global longitudinal strain and RA reservoir strain were significantly impaired immediately and midterm after surgery (all p < 0.05). Indexed left ventricular (LV) end-diastolic volume, stroke volume, as well as global longitudinal strain increased from preoperative to follow-up (all p < 0.05). Patients who achieved normalization of RV volumes after surgery had smaller severity index and RV and RA volumes and higher LV ejection fraction and RA reservoir strain at baseline than patients without RV normalization (all p < 0.05).

Conclusions

Reverse biventricular remodeling took place in EA after tricuspid valve surgery. Tricuspid valve reconstruction should be performed before deterioration of RV volume overload and LV function to achieve reverse RV remodeling.

Key Points

• After removing the volume load of tricuspid regurgitation in Ebstein’s anomaly, reverse remodeling was detected by CMR in both left and right heart at midterm follow-up.

• Tricuspid valve reconstruction should be performed before deterioration of RV volume overload and LV function to achieve reverse RV remodeling.

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Abbreviations

aRV:

Atrialized right ventricle

CMR:

Cardiac magnetic resonance

CMRs:

Cardiac magnetic resonance examinations

GLS:

Global longitudinal strain

IQR:

Interquartile range

LA:

Left atria

LV:

Left ventricular

LVEDVi:

Indexed left ventricular end-diastolic volume

LVSVi:

Indexed left ventricular stroke volume

RA:

Right atria

RV:

Right ventricle

RVEDVi:

Indexed right ventricular end-diastolic volume

RVEF:

Right ventricular ejection fraction

RVESVi:

Indexed right ventricular end-systolic volume

RVSVi:

Indexed right ventricular stroke volume

SI:

Severity index

References

  1. Attenhofer Jost CH, Connolly HM, Dearani JA, Edwards WD, Danielson GK (2007) Ebstein’s anomaly. Circulation 115(2):277–285

    Article  PubMed  Google Scholar 

  2. Celermajer DS, Bull C, Till JA et al (1994) Ebstein’s anomaly: presentation and outcome from fetus to adult. J Am Coll Cardiol 23(1):170–176

    Article  CAS  PubMed  Google Scholar 

  3. Qureshi MY, Sommer RJ, Cabalka AK (2019) Tricuspid valve imaging and intervention in pediatric and adult patients with congenital heart disease. JACC Cardiovasc Imaging 12(4):637–651

    Article  PubMed  Google Scholar 

  4. Freud LR, McElhinney DB, Kalish BT et al (2020) Risk factors for mortality and circulatory outcome among neonates prenatally diagnosed with Ebstein anomaly or tricuspid valve dysplasia: a multicenter study. J Am Heart Assoc 9(21):e016684

    Article  PubMed  PubMed Central  Google Scholar 

  5. Schultz K, Haeffele CL (2020) Heart failure in the adult Ebstein patient. Heart Fail Rev 25(4):623–632

    Article  PubMed  Google Scholar 

  6. Attenhofer Jost CH, Tan NY, Hassan A et al (2018) Sudden death in patients with Ebstein anomaly. Eur Heart J 39(21):1970–1977a

    Article  PubMed  Google Scholar 

  7. Neijenhuis RML, Tsang VT, Marek J et al (2021) Cone reconstruction for Ebstein anomaly: late biventricular function and possible remodeling. J Thorac Cardiovasc Surg 161(3):1097–1108

    Article  PubMed  Google Scholar 

  8. Beroukhim RS, Jing L, Harrild D et al (2018) Impact of the cone operation on left ventricular size, function, and dyssynchrony in Ebstein anomaly: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 20(1):32

    Article  PubMed  PubMed Central  Google Scholar 

  9. Qureshi MY, O’Leary PW, Connolly HM (2018) Cardiac imaging in Ebstein anomaly. Trends Cardiovasc Med 28(6):403–409

    Article  PubMed  Google Scholar 

  10. Schulz-Menger J, Bluemke DA, Bremerich J et al (2020) Standardized image interpretation and post-processing in cardiovascular magnetic resonance - 2020 update: Society for Cardiovascular Magnetic Resonance (SCMR): Board of Trustees Task Force on Standardized Post-Processing. J Cardiovasc Magn Reson 22(1):19

    Article  PubMed  PubMed Central  Google Scholar 

  11. Perdreau E, Tsang V, Hughes ML et al (2018) Change in biventricular function after cone reconstruction of Ebstein’s anomaly: an echocardiographic study. Eur Heart J Cardiovasc Imaging 19(7):808–815

    Article  CAS  PubMed  Google Scholar 

  12. Xu J, Yang W, Zhao S, Lu M (2022) State-of-the-art myocardial strain by CMR feature tracking: clinical applications and future perspectives. Eur Radiol 32(8):5424–5435

    Article  PubMed  Google Scholar 

  13. Monti CB, Secchi F, Capra D et al (2020) Right ventricular strain in repaired tetralogy of Fallot with regards to pulmonary valve replacement. Eur J Radiol 131:109235

    Article  PubMed  Google Scholar 

  14. Zachos P, Nevras V, Milaras N et al (2022) The value of myocardial strain imaging in the evaluation of patients with repaired tetralogy of Fallot: a review of the literature. Heart Fail Rev. https://doi.org/10.1007/s10741-022-10223-z

  15. Petersen SE, Khanji MY, Plein S, Lancellotti P, Bucciarelli-Ducci C (2019) European Association of Cardiovascular Imaging expert consensus paper: a comprehensive review of cardiovascular magnetic resonance normal values of cardiac chamber size and aortic root in adults and recommendations for grading severity. Eur Heart J Cardiovasc Imaging 20(12):1321–1331

    Article  PubMed  Google Scholar 

  16. Ibrahim M, Tsang VT, Caruana M et al (2015) Cone reconstruction for Ebstein’s anomaly: patient outcomes, biventricular function, and cardiopulmonary exercise capacity. J Thorac Cardiovasc Surg 149(4):1144–1150

    Article  PubMed  Google Scholar 

  17. Lange R, Burri M, Eschenbach LK et al (2015) Da Silva’s cone repair for Ebstein’s anomaly: effect on right ventricular size and function. Eur J Cardiothorac Surg 48(2):316–320

    Article  PubMed  Google Scholar 

  18. Oosterhof T, van Straten A, Vliegen HW et al (2007) Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance. Circulation 116(5):545–551

    Article  PubMed  Google Scholar 

  19. Kim HK, Kim YJ, Park EA et al (2010) Assessment of haemodynamic effects of surgical correction for severe functional tricuspid regurgitation: cardiac magnetic resonance imaging study. Eur Heart J 31(12):1520–1528

    Article  PubMed  Google Scholar 

  20. Aly S, Seed M, Yoo SJ, Lam C, Grosse-Wortmann L (2021) Myocardial fibrosis in pediatric patients with Ebstein’s anomaly. Circ Cardiovasc Imaging 14(3):e011136

    Article  PubMed  Google Scholar 

  21. Yang D, Li X, Sun JY et al (2018) Cardiovascular magnetic resonance evidence of myocardial fibrosis and its clinical significance in adolescent and adult patients with Ebstein’s anomaly. J Cardiovasc Magn Reson 20(1):69

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bourfiss M, Vigneault DM, Aliyari Ghasebeh M et al (2017) Feature tracking CMR reveals abnormal strain in preclinical arrhythmogenic right ventricular dysplasia/cardiomyopathy: a multisoftware feasibility and clinical implementation study. J Cardiovasc Magn Reson 19(1):66

    Article  PubMed  PubMed Central  Google Scholar 

  23. Zghaib T, Bourfiss M, van der Heijden JF et al (2018) Atrial dysfunction in arrhythmogenic right ventricular cardiomyopathy. Circ Cardiovasc Imaging 11(9):e007344

    Article  PubMed  Google Scholar 

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Funding

The study was funded by the National Key Research and Development Program of China (2021YFF0501404, 2021YFF0501400) and National Natural Science Foundation of China (No. 81930044).

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Authors and Affiliations

  1. MR Center, Fuwai Hospital, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China

    Shiqin Yu, Kai Yang, Xiuyu Chen, Minjie Lu, Shujuan Yang, Jialin Song, Keshan Ji & Shihua Zhao

  2. Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, 518055, China

    Kankan Zhao

Authors
  1. Shiqin Yu
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  2. Kai Yang
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  3. Xiuyu Chen
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  4. Minjie Lu
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  5. Kankan Zhao
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  6. Shujuan Yang
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  7. Jialin Song
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  8. Keshan Ji
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  9. Shihua Zhao
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Corresponding author

Correspondence to Shihua Zhao.

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Guarantor

The scientific guarantor of this publication is Shihua Zhao.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the institutional review board.

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Institutional review board approval was obtained.

Methodology

• retrospective

• performed at one institution

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Yu, S., Yang, K., Chen, X. et al. Cardiac remodeling after tricuspid valve repair in Ebstein’s anomaly: a magnetic resonance study. Eur Radiol 33, 2052–2061 (2023). https://doi.org/10.1007/s00330-022-09190-8

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  • DOI: https://doi.org/10.1007/s00330-022-09190-8

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