Biventricular remodeling and function after Cone repair of Ebstein Anomaly: A review
Bibliographic record
Abstract
Abstract The Cone reconstruction is the prevailing repair strategy for Ebstein anomaly (EA), providing near-anatomical restoration of the tricuspid valve (TV) and reliable reduction of tricuspid regurgitation (TR). Most of the risk of Cone repair is seen in the early postoperative period from dehiscence, with very low rates of mortality and reintervention thereafter. By correcting TV dysfunction and abnormal right ventricle (RV) geometry, ventricular reverse remodeling has been demonstrated through decreased right atrial and atrialized RV size, along with improved antegrade pulmonary flow and consequent left ventricular filling. Early postoperative RV dysfunction is common due to increased afterload upon addressing TR, with suggestion of delayed recovery. Cone repair augments left ventricular preload and preserves left ventricular function. The contrasting effects of ventricular plication and superior repositioning of TV during the Cone repair has led to discrepant reports in the trajectory of RV remodeling, which is further confounded by the lack of standardization in imaging measurements and timing of surveillance. Consistency in imaging protocol and lengthening follow-up will hopefully provide a more robust understanding about the evolution of the postoperative RV. Improvement in functional status and aerobic capacity can also be appreciated post-Cone repair, particularly in highly symptomatic patients. Innovation to promote remodeling of the Ebsteinoid heart include stem cell therapy at the time of surgical repair, which has shown promise in phase I clinical trial. Lastly, the goal of biventricular repair through Cone reconstruction can be facilitated by Starnes palliation to stabilize critical presentations, a paradigm shift that is increasingly adopted. Graphical abstract. Cone repair of Ebstein anomaly is associated with biventricular remodeling. LV, left ventricle; NYHA, New York Heart Association; QoL, quality of life; RA, right atrium; RV, right ventricle; TR, tricuspid regurgitation. • Biventricular remodeling occurs after Cone repair of Ebstein anomaly • Right atrial size decreases and left ventricle size increases post-repair • Change in right ventricular geometry is variable across studies • Early postoperative reduction of RV function later recovers • Standardization in timing and measurements of imaging surveillance is needed
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".