Anesthetic management of an adult patient with Ebstein's anomaly

Ebstein's anomaly is a rare congenital heart disease. An adult patient with Ebstein's anomaly was scheduled for Hetzer's procedure (modified tricuspid valve repair). This 36-year-old female had been diagnosed as Ebstein's anomaly and a patent foramen ovale during pregnancy, and Hetzer's repair procedure for tricuspid valve incompetence and closure of the foramen ovale were performed. The surgical techniques were chosen based on preoperative transthoracic echocardiography and intraoperative transesophageal echocardiography. During the operation, maximal attention was paid to prevent hypoxemia and paradoxical embolization. The patient's postoperative course was successful, and she was discharged from the hospital on the 14th postoperative day. Tricuspid valve regurgitation was reduced from IV to I, and New York Heart Association functional class was improved from III to I in the postoperative period. Hetzer's procedure is a useful technique for tricuspid repair of Ebstein's anomaly. Accurate morphological evaluation of the tricuspid valve by preoperative transthoracic and intraoperative transesophageal echocardiography is very important for the surgeon to plan surgery appropriately. Anesthesiologists should understand transesophageal echocardiography for congenital heart disease well.