Modified Carpentier procedure for type B Ebstein’s heart malformation

  To further improve the effectiveness of surgical treatment of Ebstein’s heart malformation, reduce complications, and decrease mortality; METHODS: Ten patients with cardiac Ebstein’s malformation belonging to Carpentier type B were treated with modified Carpentier procedure in our hospital from January 2010 to March 2013, including 5 males and 5 females. The age was 15-47 years old, average 25.6 years old, oxygen saturation was 90% in 4 cases and 91% in 6 cases.  The operation was performed under general anesthesia and hypothermic extracorporeal circulation. The right ventricular structures and tricuspid leaflet development were first explored to confirm the presence of a well-developed anterior tricuspid leaflet, and then the longitudinal folded atrialized right ventricle was continuously sutured from the inside out in a double layer. The tricuspid septum and posterior leaflet were left open. The appropriate type of prosthetic valve forming ring was then selected according to the patient’s age and weight, and the forming ring was fixed with interrupted sutures. Water is injected to check for regurgitation. Depending on the situation, appropriate repairs were then made until there was no regurgitation. In two of the patients, the right ventricle was poorly developed, and the central venous pressure reached 15 cmH2o after surgery plus a bidirectional Glenn procedure.  RESULTS: Intraoperative application of a 31-gauge shaped ring was performed in 1 case, a 29-gauge shaped ring in 6 cases, and a 27-gauge in 3 cases. The aortic block time was 45-66 minutes, with a mean of 51.5 minutes. Postoperative circulation was smooth in all cases, no 1 case died, no low heart displacement syndrome occurred, postoperative cardiac ultrasound examination: no regurgitation of tricuspid valve in 6 cases, mild regurgitation in 4 cases, cardiac function grade I in 6 cases, grade II in 4 cases. Conclusion: The modified Carpentier procedure for B-type Ebstein’s heart malformation is effective, simple and practical, and easy to promote. However, because of the small number of cases, further study is needed.