In the surgical treatment of Ebstein's anomaly, which of the following is/are true?

A. In neonates, the tricuspid valve orifice may be oversewn and a systemic-pulmonary shunt created to provide pulmonary blood flow.

D. If tricuspid valve replacement is performed, the valve should be sutured above the coronary sinus to avoid injury to the conduction system.

DISCUSSION: In a recent report on the surgical treatment of Ebstein's anomaly in neonates, Starnes described a technique consisting of oversewing the tricuspid valve, atrial septectomy, and placement of a systemic-pulmonary shunt. These patients are then later staged to a modified Fontan procedure when they outgrow their shunts. Repair of the ASD alone was performed early in the treatment of Ebstein's anomaly and was associated with high mortality rates. It is not considered an adequate repair. Most techniques in tricuspid valve repair for Ebstein's malformation utilize plication of the atrialized right ventricle in addition to excision of redundant atrial tissue. If tricuspid valve replacement is necessary, current approaches utilize bioprosthetic valves because of their excellent durability in the tricuspid position. Placement of the valve ring above the coronary sinus has been associated with a lower rate of postoperative heart block.