Tricuspid valve surgery improves cardiac output and exercise performance in patients with Ebstein's anomaly

BackgroundClinical, hemodynamic and functional effects of tricuspid valve surgery in patients with Ebstein's anomaly are not well understood.MethodsSixteen patients (median age of 27.7 years) were examined before and eight months after surgery by means of echocardiography, cardiovascular magnetic resonance (CMR) and cardiopulmonary exercise testing.ResultsPeak work load (1.87 to 2.0 W/kg; p = 0.026), maximum oxygen uptake (21 to 22 ml/kg/min; p = 0.034) as well as cardiac output (2.7 to 2.9 l/min/m2; p = 0.035) increased postoperatively. The reduction of tricuspid regurgitation led to a higher pulmonary stroke volume (29 to 42 ml/m2, p = 0.005) and augmented the left ventricular (LV) volume (55 to 63 ml/min/m2; p = 0.001) with a trend to better ejection fraction (61 to 64%; p = 0.083). Right ventricular (RV) volume index (124 to 108 ml/m2; p = 0.034) and ejection fraction (50 to 42%; p = 0.036) decreased on CMR. Echocardiographic measurements of RV function also decreased (tricuspid annular plane systolic excursion 2.3 to 1.7; p = 0.002; isovolumic acceleration 0.98 to 0.65; p = 0.004; and 2-d longitudinal global strain − 19.3 to − 16.25; p = 0.006).ConclusionTricuspid valve surgery improves exercise capacity in patients with Ebstein's anomaly. The reduction of tricuspid regurgitation decreases the volume of the right ventricle and increases pulmonary antegrade flow. As a result LV volume and cardiac output increase. This hemodynamic benefit occurs despite the preload dependent reduction in RV volume and ejection fraction.