Ebsteins anomaly of the tricuspid valve differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Claudia P. Hochberg, M.D. Maneesha Nandimandalam, M.B.B.S.[3]

Overview

Disorders that Ebstein’s anomaly must be distinguished from include:

Accessory pathway-mediated WPW syndrome and SVT
Atrial septal defect (ASD)
Cyanotic congenital heart diseases
Isolated, severe tricuspid regurgitation
L-transposition of the great vessels
Severe right heart failure with dilation of the anulus

Differentiating Ebsteins anomaly of the tricuspid valve from other diseases

Ebstein’s anomaly should be differentiated from other cynotic diseases and others^[1]^[2]^[3]


Disorders	Etiology	Clinical Presentation	Laboratory Findings	Electrocardiogram	Echocardiography
Tetralogy of Fallot	Multifactorial Genetic polymorphisms Maternal rubella Poor prenatal nutrition Maternal alcohol use Maternal diabetes	Cyanosis on exertion Exertional dyspnea Palpitations Fatigue	CBC: Anemia or polycythemia. Coagulation profile. Arterial blood gas: Low oxygen saturation and acidosis	Right ventricular hypertrophy Right bundle branch block Tachycardia Rate of QRS change predicts ventricular arrhythmia	Echocardiography may show: Residual VSD or ASD RV outflow tract obstruction Abnormal valvular anatomy
Total Anomalous Pulmonary Venous Connection	Multifactorial Genetic polymorphisms Maternal rubella Poor prenatal nutrition Maternal alcohol use Maternal diabetes	Tachypnea Palpitations Cyanosis Failure to thrive	Arterial blood gas: Low oxygen saturation and acidosis Coagulation profile.	Right ventricular hypertrophy with a qR pattern	Right ventricular hypertrophy Right ventricular loading Paradoxical septal motion
Tricuspid Atresia	Multifactorial Genetic polymorphisms Maternal rubella Poor prenatal nutrition Maternal alcohol use Maternal diabetes	Respiratory difficulties as nasal flaring or muscle retractions Cyanosis Growth retradation	Arterial blood gases CBC: Polycythemia Coagulation profile	Tall P waves indicate atrial enlargement. First-degree atrioventricular block. Frontal plane QRS axis may be leftward.	Echocardiography may show Defect size Pulmonary blood flow Ventricular function Valve abnormalities
Transposition of the Great Arteries	Multifactorial Genetic polymorphisms Poor prenatal nutrition Maternal alcohol use Maternal diabetes	Prominent cyanosis within hours of birth Congestive heart failure	Arterial blood gases: Hypoxemia Hyperoxia test	Right ventricular hypertrophy Right axis deviation Varying degrees of AV block Q waves	Echocardiography may show: Relationship between great vessels Associated anatomic lesions Coronary artery origin and branches

References

↑ Zuberi SA, Liu S, Tam JW, Hussain F, Maguire D, Kass M (2015). “Partial PFO Closure for Persistent Hypoxemia in a Patient with Ebstein Anomaly”. Case Rep Cardiol. 2015: 531382. doi:10.1155/2015/531382. PMC 4405015. PMID 25945265.
↑ 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.
↑ Romfh A, Pluchinotta FR, Porayette P, Valente AM, Sanders SP (June 2012). “Congenital Heart Defects in Adults : A Field Guide for Cardiologists”. J Clin Exp Cardiolog (Suppl 8). doi:10.4172/2155-9880.s8-007. PMC 3842121. PMID 24294540.

Template:WH

Template:WS

[pmid25945265-1] Zuberi SA, Liu S, Tam JW, Hussain F, Maguire D, Kass M (2015). “Partial PFO Closure for Persistent Hypoxemia in a Patient with Ebstein Anomaly”. Case Rep Cardiol. 2015: 531382. doi:10.1155/2015/531382. PMC 4405015. PMID 25945265.

[pmid22723533-2] 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.

[pmid24294540-3] Romfh A, Pluchinotta FR, Porayette P, Valente AM, Sanders SP (June 2012). “Congenital Heart Defects in Adults : A Field Guide for Cardiologists”. J Clin Exp Cardiolog (Suppl 8). doi:10.4172/2155-9880.s8-007. PMC 3842121. PMID 24294540.

[1]

[2]

[3]