A new technique of tricuspid valve replacement for Ebstein's anomaly.

For surgical management of Ebstein's anomaly, a new technique of tricuspid valve replacement on the true annulus, avoiding injury to the conduction system, has been developed. At operation, the valve fixation sutures are placed around the true annulus except for a part of Koch's triangle. A 3 x 3 cm xenograft patch is sutured to cover the atrioventricular node and bundle of His. The remainder of the valve fixation sutures in Koch's triangle are placed only on the patch to prevent conduction injury, and the valve fixation annulus is completed. This new technique has been applied to three patients and has preserved atrioventricular conductivity well in all cases. It is concluded that this procedure of tricuspid replacement on the true annulus can be safely applied and is remarkably effective in preventing atrioventricular conduction disturbance.