Our Summary

This research paper is about a heart condition in newborns and infants called Ebstein Anomaly (EA). The study was conducted by a team of surgeons and heart specialists from different countries, organized by the American Association for Thoracic Surgery.

The team looked at key research papers related to EA from 2000 onwards. They worked together to create a series of recommendations based on their expert opinions. These recommendations help identify which babies are at high risk of serious complications or death, and what treatments should be used.

Babies with EA who show certain symptoms, like a very enlarged heart, abnormal blood flow, a blocked pulmonary valve, or heart dysfunction, are considered high risk. If a baby is born prematurely (before 32 weeks), has been undernourished in the womb, or is in cardiogenic shock (a state where the heart can’t pump enough blood to meet the body’s needs), they are also high risk.

High-risk babies with unstable blood flow should have immediate treatment to stop the circular flow of blood in the heart. If a baby is in cardiogenic shock that doesn’t improve, a procedure called the Starnes procedure can be used as a temporary solution. After this procedure, the baby’s condition should be reassessed, and they may need further surgery.

Babies with EA who do not show high-risk features can be monitored to see if a hole in their heart called the patent ductus arteriosus (PDA) will close on its own. If the baby is stable but has significant backflow of blood in their lungs and risk of circular shunt, they should be given medicine to try to close the PDA. Babies who are stable but have poor blood flow to their lungs may need a stent or shunt to improve blood flow.

To summarize, it’s important to identify which babies with EA are at high risk so they can get the treatment they need. Babies who are very unstable might need emergency treatment or a procedure like the Starnes operation. Stable babies might just need to be monitored or require medication or a stent to help their condition.

FAQs

  1. What is Ebstein Anomaly (EA) and how does it affect newborns and infants?
  2. What treatments are recommended for high-risk babies with Ebstein Anomaly?
  3. What is the Starnes procedure and when is it used in treating babies with Ebstein Anomaly?

Doctor’s Tip

A doctor might tell a patient undergoing cardiac surgery to follow post-operative care instructions carefully, including taking prescribed medications, attending follow-up appointments, and engaging in cardiac rehabilitation to aid in recovery and prevent complications. It’s also important to maintain a healthy lifestyle with regular exercise, a balanced diet, and avoiding smoking to support overall heart health.

Suitable For

Overall, the recommendations for cardiac surgery in patients with Ebstein Anomaly are based on the severity of their symptoms and the potential risks they face. High-risk patients with unstable blood flow, cardiogenic shock, or other serious complications should receive immediate treatment, while stable patients may be monitored or given medication to help improve their condition. By following these recommendations, healthcare providers can ensure that patients with EA receive the appropriate care and interventions to improve their outcomes.

Timeline

Before cardiac surgery:

  • Babies with Ebstein Anomaly (EA) are identified as high risk if they have certain symptoms or conditions such as an enlarged heart, abnormal blood flow, or cardiogenic shock.
  • High-risk babies may undergo immediate treatment to address their condition and stabilize their blood flow.
  • Babies who are not high risk may be monitored or given medication to manage their condition.

After cardiac surgery:

  • High-risk babies may undergo a procedure like the Starnes operation to stabilize their condition.
  • After surgery, the baby’s condition should be reassessed to determine if further treatment is needed.
  • Stable babies may require medication, a stent, or a shunt to improve blood flow and manage their condition.

Overall, identifying high-risk babies with EA is crucial for providing them with the necessary treatment to improve their outcomes. Stable babies may require ongoing monitoring and management to ensure their condition is properly managed.

What to Ask Your Doctor

Questions a patient should ask their doctor about cardiac surgery for Ebstein Anomaly may include:

  1. What specific symptoms or risk factors indicate that my baby is at high risk for serious complications or death related to EA?
  2. What treatments or procedures may be necessary for my baby if they are considered high risk?
  3. How will my baby’s condition be monitored and reassessed after undergoing a procedure like the Starnes operation?
  4. What are the potential risks and benefits of medication, stents, or shunts for improving blood flow in stable babies with EA?
  5. Are there any long-term implications or follow-up care needed for babies with EA who undergo surgery or other interventions?
  6. Are there any alternative treatment options or clinical trials available for babies with EA who are considered high risk or unstable?
  7. How can I best support my baby’s recovery and overall well-being after cardiac surgery for Ebstein Anomaly?
  8. Are there any red flags or warning signs that I should watch for in my baby’s condition that may require immediate medical attention?
  9. What is the expected timeline for my baby’s recovery and when can we expect to see improvements in their symptoms or heart function?
  10. How can I ensure that my baby receives the best possible care and support from a multidisciplinary team of specialists throughout their treatment for Ebstein Anomaly?

Reference

Authors: Konstantinov IE, Chai P, Bacha E, Caldarone CA, Da Silva JP, Da Fonseca Da Silva L, Dearani J, Hornberger L, Knott-Craig C, Del Nido P, Qureshi M, Sarris G, Starnes V, Tsang V. Journal: J Thorac Cardiovasc Surg. 2024 Aug;168(2):311-324. doi: 10.1016/j.jtcvs.2024.04.018. Epub 2024 Apr 27. PMID: 38685467