neither overdistension nor thrombus in the RV. Blood drainage
from the RV appeared to be adequate.
A rare case of neonatal Ebstein’s anomaly with circular shunting
was reported. A two-stage surgical procedure was performed,
and the outcome was good.
Conflict of interest: none declared.
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eComment. Two-stage repair of Ebstein’s anormaly in a neonate
Author: Leo A. Bockeria
Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia
© The Author 2012. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.
Ebstein’s anomaly is a congenital heart disease, which rarely requires surgical
intervention in the neonatal period. Therefore, the case involving surgical treat-
ment for neonatal Ebstein’s anomaly with circular shunting by Yohsuke Yanasa et
al. is very interesting .
The clinical symptoms vary in severity depending on the anatomical malforma-
tion. Severe tricuspid regurgitation and right ventricular hypoplasia may produce a
critical state in the neonate. Concomitant pulmonary regurgitation is rare, with the
reversal of blood flow to the right ventricle, resulting in a ’circular shunt’ and ne-
cessitating urgent surgical treatment for severe neonatal Ebstein’s anomaly.
Between 2006 and 2010, 107 patients (including one neonate and one infant)
underwent surgery for Ebstein’s anomaly at Bakoulev Scientific Center for
Cardiovascular Surgery at the Russian Academy of Medical Sciences. In our prac-
tice, due to the decrease in pulmonary vascular resistance, minimal antegrade
blood flow via pulmonary valve was restored but it was not sufficient to ensure ad-
equate oxygen saturation. We performed a modified Blalock-Taussig shunt with a
4-mm graft. Postoperative oxygen saturation was 80% and the baby was dis-
charged. Six months later, a successful one and a half surgical repair was
Surgery in the neonatal period has previously focused on palliation and conver-
sion to single-ventricle physiology. Successful two-ventricle repair with good clinic-
al results can safely be performed in the neonatal period but requires an individual
approach in each case.
 Yanase Y, Watanabe M, Ishikawa N, Higami T. Surgical treatment for neonatal
Ebstein’s anomaly with circular shunting. Interact CardioVasc Thorac Surg
Y. Yanase et al. / Interactive CardioVascular and Thoracic Surgery