Ebsteins anomaly of the tricuspid valve MRI

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] and Claudia P. Hochberg, M.D. [2]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]}; Keri Shafer, M.D. [4] Priyamvada Singh, MBBS [[5]] Assistant Editor-In-Chief: Kristin Feeney, B.S. [[6]]

Overview

Magnetic resonance imaging can be helpful as a diagnostic tool in conditions where the echocardiographic findings are inconclusive. It shows apical displacement of the septal and posterior leaflets of the tricuspid valve, arialization of the right ventricle and tricuspid regurgitation.

Magnetic resonance imaging

Magnetic resonance imaging (MRI) can be used as a diagnostic modality in the evaluation of the patient who is suspected to have Ebstein’s anomaly if the echocardiogram is inconclusive..^[1]^[2]^[3]^[4]
It shows apical displacement of the septal and posterior leaflets of the tricuspid valve, arialization of the right ventricle and tricuspid regurgitation.

Advantages of MRI

It can be used in cases where echocardiographic results are inconclusive.
Helps in measuring heart volumes, blood flow and ventricular wall thickness.
The magnetic resonance angiography helps in better visualization of heart vasculature and measuring the size the pulmonary arteries
Phase velocity mapping helps in measuring the ratio of pulmonary to systemic blood flow (Qp:Qs).

Disadvantages of MRI

For successful MRI procedure breath holding is required, which is sometimes difficult to achieve with small kids.
Some patients may become claustrophobic.
Due to the above, the procedure is sometimes done under general anesthesia in children.
There may be limited expertise to interpret the MRI as well.

ACC/AHA 2018 Guidelines for the Diagnostic recommendations of Adults With Ebstein Anomaly(DO NOT EDIT)^[5]^[6]

Class IIa
1.. In adults with Ebstein anomaly, CMR(cardiac magnetic resonance imaging) can be useful to determine anatomy, RV dimensions, and systolic function. (Level of Evidence: B)

References

↑ Eustace S, Kruskal JB, Hartnell GG (1994). “Ebstein’s anomaly presenting in adulthood: the role of cine magnetic resonance imaging in diagnosis”. Clinical Radiology. 49 (10): 690–2. PMID 7955830. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
↑ Yang D, Li X, Sun JY, Cheng W, Greiser A, Zhang TJ, Liu H, Wan K, Luo Y, An Q, Chung YC, Han Y, Chen YC (September 2018). “Cardiovascular magnetic resonance evidence of myocardial fibrosis and its clinical significance in adolescent and adult patients with Ebstein’s anomaly”. J Cardiovasc Magn Reson. 20 (1): 69. doi:10.1186/s12968-018-0488-1. PMC 6158838. PMID 30257686.
↑ Kilner PJ (2011). “The role of cardiovascular magnetic resonance in adults with congenital heart disease”. Prog Cardiovasc Dis. 54 (3): 295–304. doi:10.1016/j.pcad.2011.07.006. PMC 3245850. PMID 22014496.
↑ Kilner PJ (December 2011). “Imaging congenital heart disease in adults”. Br J Radiol. 84 Spec No 3: S258–68. doi:10.1259/bjr/74240815. PMC 3473918. PMID 22723533.
↑ Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF (April 2019). “2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines”. J. Am. Coll. Cardiol. 73 (12): e81–e192. doi:10.1016/j.jacc.2018.08.1029. PMID 30121239.
↑ Stout, Karen K.; Daniels, Curt J.; Aboulhosn, Jamil A.; Bozkurt, Biykem; Broberg, Craig S.; Colman, Jack M.; Crumb, Stephen R.; Dearani, Joseph A.; Fuller, Stephanie; Gurvitz, Michelle; Khairy, Paul; Landzberg, Michael J.; Saidi, Arwa; Valente, Anne Marie; Van Hare, George F. (2019). “2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease”. Journal of the American College of Cardiology. 73 (12): e81–e192. doi:10.1016/j.jacc.2018.08.1029. ISSN 0735-1097.

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[pmid7955830-1] Eustace S, Kruskal JB, Hartnell GG (1994). “Ebstein’s anomaly presenting in adulthood: the role of cine magnetic resonance imaging in diagnosis”. Clinical Radiology. 49 (10): 690–2. PMID 7955830. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)

[pmid30257686-2] Yang D, Li X, Sun JY, Cheng W, Greiser A, Zhang TJ, Liu H, Wan K, Luo Y, An Q, Chung YC, Han Y, Chen YC (September 2018). “Cardiovascular magnetic resonance evidence of myocardial fibrosis and its clinical significance in adolescent and adult patients with Ebstein’s anomaly”. J Cardiovasc Magn Reson. 20 (1): 69. doi:10.1186/s12968-018-0488-1. PMC 6158838. PMID 30257686.

[pmid22014496-3] Kilner PJ (2011). “The role of cardiovascular magnetic resonance in adults with congenital heart disease”. Prog Cardiovasc Dis. 54 (3): 295–304. doi:10.1016/j.pcad.2011.07.006. PMC 3245850. PMID 22014496.

[pmid22723533-4] Kilner PJ (December 2011). “Imaging congenital heart disease in adults”. Br J Radiol. 84 Spec No 3: S258–68. doi:10.1259/bjr/74240815. PMC 3473918. PMID 22723533.

[pmid30121239-5] Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF (April 2019). “2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines”. J. Am. Coll. Cardiol. 73 (12): e81–e192. doi:10.1016/j.jacc.2018.08.1029. PMID 30121239.

[StoutDaniels2019-6] Stout, Karen K.; Daniels, Curt J.; Aboulhosn, Jamil A.; Bozkurt, Biykem; Broberg, Craig S.; Colman, Jack M.; Crumb, Stephen R.; Dearani, Joseph A.; Fuller, Stephanie; Gurvitz, Michelle; Khairy, Paul; Landzberg, Michael J.; Saidi, Arwa; Valente, Anne Marie; Van Hare, George F. (2019). “2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease”. Journal of the American College of Cardiology. 73 (12): e81–e192. doi:10.1016/j.jacc.2018.08.1029. ISSN 0735-1097.

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