Successful surgery for rare congenital heart disease

  Recently, the Department of Surgery of our hospital successfully performed atrialized right ventricular folding + tricuspid valvuloplasty for the correction of an adult patient with a rare congenital heart disease, tricuspid valve subluxation malformation. The patient, Chen Moumou, female, 17 years old, came to the hospital with recurrent active palpitations and shortness of breath that prevented her from working and living normally for many years. On admission, she was diagnosed with congenital heart disease and a tricuspid valve inferiorly displaced malformation.  After admission and active preoperative preparation, she underwent a highly technically challenging atrialized right ventricular folding + tricuspid valvuloplasty surgery on October 28, 2009, with the chief surgeon Lan Bin, assisted by Dr. Chen-Sheng Ma, Dr. Rui-Xiong Li, and Dr. Chun-Ming Guo, deputy chief of the Department of Anesthesiology. The patient had a severe tricuspid inferior displacement of the tricuspid annulus, about 2-3 cm, resulting in a small right ventricular volume and intracardiac conduction system variation; at the same time, due to the low incidence of the disease and the complex and varied cardiac malformations, the surgery could easily lead to severe atrioventricular block and postoperative right heart insufficiency, making the operation technically difficult and surgical risky. After the joint efforts of all the surgical team members, the operation went smoothly and the heart resumed normal rhythm soon after the resumption.  Tricuspid valve subluxation is a rare congenital heart malformation, and it was first reported by Ebstein in 1866, so it is also called Ebstein malformation. Its incidence is only 4-8 out of 100,000 normal people, accounting for only 0.5-1% of congenital heart disease, and it is an extremely rare congenital heart malformation. The pathologic anatomic alteration of the disease is the displacement of the tricuspid valve into the right ventricle, mainly by the septal and posterior leaflets, which often attach to the right ventricular wall near the apex rather than to the fibrous annulus of the tricuspid valve, thus dividing the right ventricle into two chambers, the “atrialized right ventricle” and the “functional right ventricle,” making the normal right ventricular cavity smaller. The malformed tricuspid valve leads to severe tricuspid valve insufficiency and right heart insufficiency and arrhythmia, often accompanied by atrial septal defect, ventricular septal defect, patent ductus arteriosus, pulmonary artery stenosis or atresia, and, in severe cases, cyanosis. The prognosis of the disease also varies widely, with most patients clinically dying before the age of 20.