Cone Repair for Ebstein’s Anomaly of the Tricuspid Valve with Posterior Leaflet Patch Extension

Cone repair for Ebstein’s anomaly has become the preferred surgical strategy for the tricuspid valve. As the severity in the abnormalities of the posterior and septal tricuspid valve leaflet varies significantly in this condition, surgical techniques need to adapt and change accordingly. This video shows the surgical repair of Ebstein’s anomaly in a forty-three-year-old woman who presented with increasing shortness of breath and fatigue (NYHA III) associated with severe tricuspid valve regurgitation and dilated right-sided heart chambers. 

The operation was performed via median sternotomy and mild hypothermia (35 C). The posterior and septal leaflets of the tricuspid valve were severely displaced apically and there was a significant loss of posterior leaflet tissue. The entire valve was detached from the annulus, and all the muscle bundles attached to the leaflets were resected. After plicating the atrialized portion of the right ventricle, the cone geometry was created and the valve was reimplanted into the neoannulus of the tricuspid valve. Just below the coronary sinus area, the posterior leaflet was augmented with autologous pericardium in order to avoid any tension and increase the coaptation area. The postoperative echocardiogram showed a well-functioning tricuspid valve, and the comparison between the pre- and postoperative short axis view demonstrated the significantly improved coaptation area and the bileaflet appearance of the repaired tricuspid valve. The patient’s postoperative course was uneventful.