Successful Hybrid Procedure in Patients with Ebstein`s Anomaly, Severe Cyanosis and Pulmonary Hypertension

We present a clinical case of huge 49 years old woman (BSA – 2,52 m²), who was admitted in our hospital in a bad condition with diagnosis: Ebstein`s anomaly, tricuspid valve insufficiency grade 4, chronic arterial hypoxemia, high pulmonary hypertension, open foramen ovale (7 mm), right bundle branch block, paroxysmal atrial fibrillation, NYHA Class IV. Obesity (bmi - 37,2/m²). Ischemic stroke in anamnesis.

A two-step hybrid treatment strategy has been developed and completed. At first we performed open-heart surgery by replacing the tricuspid valve with a bioprosthesis and maintaining the foramen ovale intact. Seven days later we did endovascular intervention by closing the foramen ovale with an occluder.

After the first operation, we observed signs of insufficiency of the right ventricle with gradual improvement, appearance of the left-right shunt through the foramen ovale, and low saturation without metabolic disturbances.

After the second intervention, we achieved great improvement both in the parameters of the patients oxygenation and functional status.

We believe this strategy could be used in surgical patients with high pulmonary hypertension as alternative to the composite unidirectional patch.