Advertisement

Pediatric Cardiology

, Volume 40, Issue 4, pp 726–732 | Cite as

Exercise Capacity After Repair of Ebstein Anomaly in Adults

  • Brandon D. Morrical
  • Joseph A. Dearani
  • Crystal R. Bonnichsen
  • Nathaniel W. TaggartEmail author
Original Article

Abstract

Repair of Ebstein anomaly has evolved over the last decade, and timing of repair remains variable. There have been no studies of exercise or functional capacity in patients who have had tricuspid valve surgery for Ebstein anomaly in adulthood. We aimed to compare exercise capacity before and after tricuspid valve repair or replacement for Ebstein anomaly in adults at Mayo Clinic. We performed a retrospective chart review of all patients with Ebstein anomaly who underwent tricuspid valve surgery at Mayo Clinic between June 2007 and January 2015. We compared pre- and postoperative echocardiograms, exercise tests, and clinic visits. Tricuspid valve surgery was done for 322 patients, and 32 patients met criteria of native tricuspid valve repair or replacement at age 18 or older and had maximal pre- and postoperative exercise tests. Nineteen patients had valve repair, and 13 had valve replacement. Surgery for Ebstein anomaly resulted in significant reduction in tricuspid regurgitation and right ventricular size. There was a significant improvement in NYHA functional class after surgery; however, there was no significant improvement in functional aerobic capacity (FAC), metabolic equivalents (METs), exercise time, or \({\text{V}}{{\text{O}}_{{2_{\hbox{max} }}}}\) after surgery. Patients who had an atrial shunt closed during surgery had improved minimum blood oxygen saturations during exercise, though no improvement in exercise capacity. In our cohort, patients who had tricuspid valve repair or replacement for Ebstein anomaly reported an improvement in functional capacity; however, this did not reflect improvement in measured exercise capacity, despite excellent surgical results by echocardiography.

Keywords

Ebstein anomaly Exercise Stress testing Adult congenital Tricuspid valve 

Notes

Acknowledgements

The authors would like to thank David Driscoll, MD, for his expertise and assistance with this manuscript.

Compliance with Ethical Standards

Conflict of interest

All authors declare no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This retrospective study was approved by our internal IRB board.

Informed Consent

As this study was retrospective, no informed consent was obtained.

References

  1. 1.
    da Silva JP, Baumgratz JF, da Fonseca L et al (2007) The cone reconstruction of the tricuspid valve in Ebstein’s anomaly. The operation: early and midterm results. J Thorac Cardiovasc Surg 133:215–223CrossRefPubMedGoogle Scholar
  2. 2.
    Driscoll DJ, Mottram CD, Danielson GK (1988) Spectrum of exercise intolerance in 45 patients with Ebstein’s anomaly and observations on exercise tolerance in 11 patients after surgical repair. J Am Coll Cardiol 11:831–836CrossRefPubMedGoogle Scholar
  3. 3.
    MacLellan-Tobert SG, Driscoll DJ, Mottram CD, Mahoney DW, Wollan PC, Danielson GK (1997) Exercise tolerance in patients with Ebstein’s anomaly. J Am Coll Cardiol 29:1615–1622CrossRefPubMedGoogle Scholar
  4. 4.
    Kipps AK, Graham DA, Lewis E, Marx GR, Banka P, Rhodes J (2012) Natural history of exercise function in patients with Ebstein anomaly: a serial study. Am Heart J 163:486–491CrossRefPubMedGoogle Scholar
  5. 5.
    Muller J, Kuhn A, Vogt M, Schreiber C, Hess J, Hager A (2011) Improvements in exercise performance after surgery for Ebstein anomaly. J Thorac Cardiovasc Surg 141:1192–1195CrossRefPubMedGoogle Scholar
  6. 6.
    Muller J, Kuhn A, Tropschuh A et al (2016) Exercise performance in Ebstein’s anomaly in the course of time - Deterioration in native patients and preserved function after tricuspid valve surgery. Int J Cardiol 218:79–82CrossRefPubMedGoogle Scholar
  7. 7.
    Jette M, Sidney K, Blumchen G (1990) Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity. Clin Cardiol 13:555–565CrossRefPubMedGoogle Scholar
  8. 8.
    Brown ML, Dearani JA, Danielson GK et al (2008) Functional status after operation for Ebstein anomaly: the Mayo Clinic experience. J Am Coll Cardiol 52:460–466CrossRefPubMedGoogle Scholar
  9. 9.
    Chen SSM, Dimopoulos K, Sheehan FH, Gatzoulis MA, Kilner PJ (2016) Physiologic determinants of exercise capacity in patients with different types of right-sided regurgitant lesions: Ebstein’s malformation with tricuspid regurgitation and repaired tetralogy of Fallot with pulmonary regurgitation. Int J Cardiol 205:1–5CrossRefPubMedGoogle Scholar
  10. 10.
    Ibrahim M, Tsang VT, Caruana M et al (2015) Cone reconstruction for Ebstein’s anomaly: Patient outcomes, biventricular function, and cardiopulmonary exercise capacity. J Thorac Cardiovasc Surg 149:1144–1150CrossRefPubMedGoogle Scholar
  11. 11.
    Anderson HN, Dearani JA, Said SM et al (2014) Cone reconstruction in children with Ebstein anomaly: the Mayo Clinic experience. Congenit Heart Dis 9:266–271CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Pediatric CardiologyMayo ClinicRochesterUSA
  2. 2.Department of Cardiovascular SurgeryMayo ClinicRochesterUSA
  3. 3.Divsion of Cardiology, Department of Adult Congenital CardiologyMayo ClinicRochesterUSA

Personalised recommendations