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

• Published in: European radiology 2023-03, Vol.33 (3), p.2052-2061
• Main Authors: Yu, Shiqin, Yang, Kai, Chen, Xiuyu, Lu, Minjie, Zhao, Kankan, Yang, Shujuan, Song, Jialin, Ji, Keshan, Zhao, Shihua
• Format: Article
• Language: English
• Subjects: Adult; Cardiac; Diagnostic Radiology; Ebstein Anomaly - diagnostic imaging; Ebstein Anomaly - pathology; Ebstein Anomaly - surgery; Ejection fraction; Heart; Heart Failure; Humans; Imaging; Internal Medicine; Interventional Radiology; Magnetic resonance; Magnetic Resonance Spectroscopy; Medicine; Medicine & Public Health; Neuroradiology; Overloading; Radiology; Reconstructive surgery; Regurgitation; Resonance; Retrospective Studies; Stroke volume; Surgery; Tricuspid valve; Tricuspid Valve - diagnostic imaging; Tricuspid Valve - pathology; Tricuspid Valve - surgery; Ultrasound; Ventricle; Ventricular Function, Right; Ventricular Remodeling
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-022-09190-8

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 .