Ebstein repair at high altitude setting ≥ 2,500 m - First experience from Bolivia.

Background: Contemporary surgical approaches for Ebstein anomaly are based on a paradigm shift towards earlier surgery in order to avoid the deleterious effects of chronic right ventricular (RV) volume overload. In addition, RV dysfunction may worsen in the setting of high altitude and, to date, no results on Ebstein anomaly surgery have been reported from a high altitude setting.

Methods: We herein present first postoperative results from Ebstein anomaly patients who underwent cone reconstruction (with or without bi-directional Glenn anastomosis) in Cochabamba, Bolivia (> 2,500 m above sea level) using a specific high altitude protocol for prophylactic medical treatment of presumed pulmonary hypertension including sildenafil, iloprost, and higher FiO2.

Results: Four patients underwent surgical correction of Ebstein anomaly (median age 9 years, range 4 to 12 years, all female). Ebstein anomaly was classified as Carpentier type C in three and as Carpentier Type B in one patient. All patients showed some degree of atrial shunting while one patient exhibited an additional perimembranous ventricular septal defect. All underwent cone reconstruction of the tricuspid valve. Due to massive intraoperative bleeding, which required re-thoracotomy subsequently causing impaired RV function, one patient underwent concomitant "one and half ventricle" repair. All other patients showed an uncomplicated postoperative course and all were alive with a good and/or improved RV function and only minimal-to-mild tricuspid regurgitation after 1 year.

Discussion: Cone reconstruction in children with Ebstein anomaly is feasible in a high altitude setting when using a dedicated protocol to prophylactically manage pulmonary hypertension.