{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T14:07:11Z","timestamp":1786630031042,"version":"build-2736575974"},"reference-count":29,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","award":["Ricerca Corrente"],"award-info":[{"award-number":["Ricerca Corrente"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,12,15]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ebstein\u2019s anomaly (EA) exhibits significant anatomical and clinical heterogeneity, warranting a systematic approach to risk stratification. While the Carpentier classification (CC) is commonly employed for qualitative disease assessment, there is increasing interest in quantitative imaging parameters to personalise monitoring strategies and therapeutic interventions. We sought to evaluate the association between cardiovascular magnetic resonance (CMR) parameters, CC and symptoms of heart failure (HF). Also, we investigated whether CMR-derived markers may predict the need for bidirectional cavopulmonary anastomosis (BCPA) and the occurrence of haemodynamic complications or significant right ventricular (RV) dysfunction in the postoperative stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study evaluated consecutive patients diagnosed with EA undergoing 1.5T CMR acquisition at a tertiary care centre. CC and quantitative indices were extracted from steady-state free precession sequences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In a total population of 60 patients (53% male, median age 22 years), CMR parameters most strongly associated (p&lt;0.001) with CC included indexed displacement of the septal (SLDi) and inferior (ILDi) leaflets, Ebstein valve rotation angle, functional RV ejection fraction, indexed atrialised RV end-diastolic volume and the ratio of either atrialised or functional RV to anatomical RV. Decreasing left ventricular ejection fraction (OR 0.85, 95%\u2009CI 0.75 to 0.97, p=0.01) and increasing ILDi (OR 1.05, 95%\u2009CI 1.00 to 1.10, p=0.04) emerged as the most prominent variables associated with HF symptoms. Additionally, ILDi was significantly linked to the need for BCPA (OR 1.15, 95%\u2009CI 1.03 to 1.28), the occurrence of haemodynamic complications (OR 1.09, 95%\u2009CI 1.01 to 1.18) and significant RV dysfunction in the postoperative stay (OR 1.08, 95%\u2009CI 1.01 to 1.17).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Quantitative CMR indices proved to be effective in distinguishing between Carpentier classes and they may be valuable in an integrated CMR-based approach to assess EA severity. Among these, ILDi reflects both the extent of tricuspid valve abnormality and RV atrialisation and may serve as a useful metric in guiding personalised therapeutic strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003741","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T08:40:25Z","timestamp":1767775225000},"page":"e003741","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Anatomical severity of Ebstein\u2019s anomaly: a quantitative analysis based on cardiovascular MRI"],"prefix":"10.1136","volume":"13","author":[{"given":"Giulia","family":"Pasqualin","sequence":"first","affiliation":[{"name":"Pediatric and Congenital Heart Disease Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy"},{"name":"PhD Degree Program in Cardio-Nephro-Thoracic Sciences, University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7317-304X","authenticated-orcid":false,"given":"Francesco","family":"Sturla","sequence":"additional","affiliation":[{"name":"3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy"},{"name":"Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Cavazza","sequence":"additional","affiliation":[{"name":"Pediatric and Congenital Heart Disease Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Tondi","sequence":"additional","affiliation":[{"name":"Multimodality Imaging Cardiac Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy"},{"name":"Postgraduate School in Radiodiagnostics, Universit\u00e0 degli Studi di Milano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliana","family":"Abbate","sequence":"additional","affiliation":[{"name":"Pediatric and Congenital Heart Disease Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Bevilacqua","sequence":"additional","affiliation":[{"name":"Pediatric and Congenital Heart Disease Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Torchio","sequence":"additional","affiliation":[{"name":"Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Hughes","sequence":"additional","affiliation":[{"name":"Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Micaglio","sequence":"additional","affiliation":[{"name":"Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy"},{"name":"Institute of Molecular and Translational Cardiology (IMTC), San Donato Milanese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Multimodality Imaging Cardiac Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Spagnolo","sequence":"additional","affiliation":[{"name":"Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Pappone","sequence":"additional","affiliation":[{"name":"Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy"},{"name":"Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"Angeli","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy"},{"name":"Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7432-4815","authenticated-orcid":false,"given":"Massimo","family":"Chessa","sequence":"additional","affiliation":[{"name":"Pediatric and Congenital Heart Disease Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy"},{"name":"Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Giamberti","sequence":"additional","affiliation":[{"name":"Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy"},{"name":"Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,6]]},"reference":[{"key":"2026010700401471000_13.1.e003741.1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2023-322420"},{"key":"2026010700401471000_13.1.e003741.2","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/S0022-5223(19)35302-4","article-title":"A new reconstructive operation for Ebstein\u2019s anomaly of the tricuspid valve","volume":"96","author":"Carpentier","year":"1988","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026010700401471000_13.1.e003741.3","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(92)90291-T"},{"key":"2026010700401471000_13.1.e003741.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12968-020-00682-4","article-title":"SCMR Position Paper (2020) on clinical indications for cardiovascular magnetic resonance","volume":"22","author":"Leiner","year":"2020","journal-title":"J Cardiovasc Magn Reson"},{"key":"2026010700401471000_13.1.e003741.5","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-011-9923-1"},{"key":"2026010700401471000_13.1.e003741.6","first-page":"215","article-title":"The cone reconstruction of the tricuspid valve in Ebstein\u2019s anomaly","volume":"133","author":"Silva JP","year":"2007","journal-title":"The Operation: Early and Midterm Results J Thorac Cardiovasc Surg"},{"key":"2026010700401471000_13.1.e003741.7","doi-asserted-by":"crossref","first-page":"e158","DOI":"10.1016\/j.jtcvs.2025.08.012","article-title":"Cardiovascular Magnetic Resonance in decision making for patients with Ebstein anomaly: A call for action","volume":"170","author":"Pasqualin","year":"2025","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026010700401471000_13.1.e003741.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2003.09.056"},{"key":"2026010700401471000_13.1.e003741.9","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2017-311274"},{"key":"2026010700401471000_13.1.e003741.10","doi-asserted-by":"publisher","DOI":"10.4065\/80.3.361"},{"key":"2026010700401471000_13.1.e003741.11","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeab253"},{"key":"2026010700401471000_13.1.e003741.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2011.08.004"},{"key":"2026010700401471000_13.1.e003741.13","doi-asserted-by":"crossref","DOI":"10.1186\/s12968-019-0546-3","article-title":"A simple measure of the extent of Ebstein valve rotation with cardiovascular magnetic resonance gives a practical guide to feasibility of surgical cone reconstruction","volume":"21","author":"Hughes","year":"2019","journal-title":"J Cardiovasc Magn Reson"},{"key":"2026010700401471000_13.1.e003741.14","first-page":"1834","article-title":"Severity Scores for Ebstein Anomaly: Credibility and Usefulness of Echocardiographic vs Magnetic Resonance Assessments of the Celermajer Index","volume":"35","author":"Cieplucha","year":"2019","journal-title":"Can J Cardiol"},{"key":"2026010700401471000_13.1.e003741.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2010.10.058"},{"key":"2026010700401471000_13.1.e003741.16","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.113.001467"},{"key":"2026010700401471000_13.1.e003741.17","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2333"},{"key":"2026010700401471000_13.1.e003741.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2018.07.058"},{"key":"2026010700401471000_13.1.e003741.19","doi-asserted-by":"crossref","first-page":"1970","DOI":"10.1093\/eurheartj\/ehx794","article-title":"Sudden death in patients with Ebstein anomaly","volume":"39","author":"Attenhofer Jost","year":"2018","journal-title":"Eur Heart J"},{"key":"2026010700401471000_13.1.e003741.20","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2011.02161.x"},{"key":"2026010700401471000_13.1.e003741.21","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(99)01265-5"},{"key":"2026010700401471000_13.1.e003741.22","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1016\/j.hrthm.2020.01.013","article-title":"Examination of pathologic features of the right atrioventricular groove in hearts with Ebstein anomaly and correlation with arrhythmias","volume":"17","author":"Marcondes","year":"2020","journal-title":"Heart Rhythm"},{"key":"2026010700401471000_13.1.e003741.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2006.12.007"},{"key":"2026010700401471000_13.1.e003741.24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jtcvs.2025.03.014","article-title":"The American Association for Thoracic Surgery (AATS) 2025 Expert Consensus Document: Management of Ebstein anomaly in children and adults","volume":"170","author":"Chai","year":"2025","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026010700401471000_13.1.e003741.25","doi-asserted-by":"publisher","DOI":"10.1007\/s10741-019-09778-1"},{"key":"2026010700401471000_13.1.e003741.26","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1007\/s10554-025-03377-y","article-title":"Intracavitary blood flow dynamics in the systemic right ventricle after atrial switch operation: a shift from transverse to longitudinal systolic pattern","volume":"41","author":"Pasqualin","year":"2025","journal-title":"Int J Cardiovasc Imaging"},{"key":"2026010700401471000_13.1.e003741.27","article-title":"Cardiac MRI predictors of right ventricular dysfunction after the Da Silva cone operation for Ebstein\u2019s anomaly","volume":"7","author":"Alsaied","year":"2022","journal-title":"Int J Cardiol Congenit Heart Dis"},{"key":"2026010700401471000_13.1.e003741.28","article-title":"Mid-Term Recovery of Right Ventricular Function and Improvement of Left Ventricular Function After Da Silva Cone Procedure for Ebstein Anomaly","volume":"12","author":"Sundaram","year":"2025","journal-title":"J Cardiovasc Dev Dis"},{"key":"2026010700401471000_13.1.e003741.29","doi-asserted-by":"publisher","DOI":"10.1111\/chd.12155"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2025-003741","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T08:40:30Z","timestamp":1767775230000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2025-003741"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,6]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/openhrt-2025-003741"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2025-003741","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}