Ebstein's anomaly of the tricuspid valve echocardiography or ultrasound

and Claudia P. Hochberg, M.D. [mailto:chochber@bidmc.harvard.edu]

Associate Editor-In-Chief: }; Keri Shafer, M.D. [mailto:kshafer@bidmc.harvard.edu] Priyamvada Singh, MBBS mailto:psingh@perfuse.org

Assistant Editor-In-Chief: Kristin Feeney, B.S. mailto:kfeeney@perfuse.org

Echocardiogram
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

Findings on echo are-


 * Apical displacement of the anterior tricuspid valve leaflet
 * '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:



