Postoperative persistent diastolic dyssynchronous expansion in patients with Ebstein's anomaly

• Published in: PloS one Vol. 14; no. 8; p. e0220890
• Main Authors: Kim, Kyung-Jin, Kim, Kyung-Hwan, Kim, Woong-Han, Sohn, Dae-Won
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 08-08-2019; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Biology and Life Sciences; Cardiology; Cardiovascular disease; Collaboration; Congenital diseases; Diastole; Ebstein Anomaly - physiopathology; Ebstein's anomaly; Echocardiography; Expansion; Female; Health aspects; Heart; Heart rate; Heart surgery; Heart Ventricles - physiopathology; Hospitals; Humans; Infants; Internal medicine; Magnetic resonance; Magnetic Resonance Imaging; Male; Medical research; Medicine; Medicine and Health Sciences; Newborn babies; Patients; Physical Sciences; Postoperative Period; Research and Analysis Methods; Retrospective Studies; Surgery; Task forces; Tethering; Tricuspid valve; Tricuspid Valve - physiopathology; Ventricle; Ventricular Function, Right; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0220890

In Ebstein's anomaly, maximal expansion in the atrialized right ventricle (RV) occurs during early diastole, whereas that of the functional RV occurs in late diastole, resulting in diastolic dyssynchronous expansion (DSE). We quantitatively assessed DSE and identified preoperative factors correlated with persistent DSE after surgery. Seventeen patients diagnosed with Ebstein's anomaly in whom transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) images available were retrospectively analyzed for quantitative DSE assessment and 10 patients who underwent surgery and postoperative TTE available were additionally analyzed for postoperative DSE. Severity of DSE was assessed by the time difference of maximal expansion between the atrialized and functional RV divided by the cardiac cycle length × 100 ("DSE index"). Relations between DSE and, clinical, electrophysiologic parameters and the severity of tricuspid valve (TV) tethering (the RV length / tethering height during diastole: "Tethering index") were assessed. In total patients, median DSE index and tethering index were 30.3 and 2.1 respectively, and the DSE index was correlated with tethering index (rs = 0.664, P = 0.004). In 10 patients who underwent surgery, this association remained after surgery and at 2-year follow up. Tethering index ≥2.5 separated patients with and without persistent DSE. In conclusion, DSE exists in Ebstein's anomaly. DSE index is related to the tethering index and DSE persists postoperatively if tethering index ≥ 2.5. As the persistent DSE might possibly impede the optimal recovery of RV function after surgery, severity of TV tethering should take into account in considering surgery.