Ebsteins anomaly of the tricuspid valve echocardiography or ultrasound

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

Overview

Apical displacement of the anterior tricuspid valve leaflet can be seen.’Atrialized’ proximal portion of right ventricle. This occurs due to anterior displacement of tricuspid valve leaflet.Tricuspid regurgitation presenting as paradoxical septal motion. In Ebstein’s, the tricuspid valve closes 50 to 60 msec after the mitral valve.

Fetal Echocardiography

Fetal echocardiography helps in intrauterine diagnosis of Ebstein’s anomaly.

Two-dimensional echocardiography along with Doppler ultrasonography helps in making a diagnosis of Ebstein’s anomaly. Echocardiography helps in

Identifying the lesion
Determining the severity of dilatation of the right atrium
Finding other associated cardiac defects that may be present
Finding the functional status of the tricuspid valve as well as the right ventricle

Echocardiographic Findings

Apical displacement of the anterior tricuspid valve leaflet can be seen.
‘Atrialized’ proximal portion of right ventricle. This occurs due to anterior displacement of tricuspid valve leaflet.
Tricuspid regurgitation presenting as paradoxical septal motion.
Patent foramen ovale or atrial septal defect may present as right to left shunting.
Normally the tricuspid valve closes within 30 msec of the mitral valve. In Ebstein’s, the tricuspid valve closes 50 to 60 msec after the mitral valve.
The delayed tricuspid closure is not due to RBBB because it also occurs with preexcitation.
2D Echo allows you to assess whether the repair can be accomplished without a prosthetic valve, and detects whether an interatrial shunt is present.

See Echo in Ebstein’s anomaly of the tricuspid valve for more info/images

Below is an apical 4-chamber transthoracic view, showing apically-displaced leaflets of the tricuspid valve. Note substantial tricuspid regurgitation, which originates close to the apex, where the abnormal leaflets actually coapt:

ACC/AHA 2018 Guidelines for the Diagnostic recommendations of Adults With Ebstein Anomaly(DO NOT EDIT)^[1]^[2]

Class IIa
1.. In adults with Ebstein anomaly, TEE(transesophageal echo) can be useful for surgical planning if TTE(transthoracic echo) images are inadequate to evaluate tricuspid valve morphology and function. (Level of Evidence: B)

References

↑ 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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[pmid30121239-1] 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.

[StoutDaniels2019-2] 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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