Echocardiography in the diagnosis of Ebstein's anomaly

Variability in the time interval between tricuspid and mitral valve closure in Ebstein's anomaly

The time interval between mitral and tricuspid valve closure was measured from M-mode echocardiograms in patients with Ebstein's anomaly. It was found that this time interval demonstrated a range of values within each patient. The use of different transducer positions on the chest wall was found to be the predominant factor. There was no correlation between the measured time interval, its variability, and the moment of measurement during breathing. However, a period of breathholding significantly reduced the variability. This study indicates that a wide range of time intervals might be measured in a single patient. We conclude therefore, that this parameter should be used with great care in the diagnosis of Ebstein's anomaly.

Two-dimensional echocardiographic spectrum of Ebstein's anomaly: detailed anatomic assessment

This report details the two-dimensional echocardiographic assessment of 41 patients with Ebstein's anomaly. The anatomic spectrum of Ebstein's anomaly is correlated with surgical and autopsy observations in 66% of these patients. Morphologic abnormalities of the tricuspid valve and right heart structures were uniquely assessed by noninvasive two-dimensional echocardiographic examination. Features of the tricuspid valve that best related to decreased functional capacity were: 1) absence of the septal leaflet, and 2) pronounced tethering, restriction of motion and displacement of the anterior leaflet of the tricuspid valve. This 4 1/2 year experience suggests that two-dimensional echocardiography can replace angiography as the procedure of choice for diagnostic and morphologic assessment of Ebstein's anomaly. Cardiac catheterization is necessary only when specific hemodynamic questions or clinical inconsistencies exist.

Value of M-mode echocardiography for non-invasive diagnosis of Ebstein's anomaly

M-mode echocardiographic studies were performed in 11 patients, most of them adults, with Ebstein's anomaly of the tricuspid valve, proven by cardiac catheterisation. Simultaneous recordings of the tricuspid and mitral valves were obtained in all cases, the transducer position being outside the left midclavicular line in seven patients. Tricuspid valve closure followed mitral valve closure in all cases, with an interval ranging between 0.04 and 0.14 s. Since, in more than 8500 routine echocardiographic studies a valve closure interval between 0.09 and 0.12 s was seen in only one patient without Ebstein's anomaly, an interval of 0.065 s or more should be regarded as diagnostic of Ebstein's disease; however, an interval shorter than 0.065 s does not exclude this diagnosis. In all patients a paradoxical septal movement was found. Two patients showed an atypical three-peaked diastolic pattern of movement of the anterior tricuspid leaflet and one patient also showed mitral valve prolapse. Pathological tricuspid valve closure delay, shown by echocardiography, makes it possible to diagnose Ebstein's anomaly in many cases without resort to cardiac catheterisation which has a relatively high risk in this disease.

Left ventricular anomalies associated with Ebstein's malformation of the tricuspid valve

Seventeen patients with Ebstein's malformation of the tricuspid valve have been evaluated. The majority of patients (11/17) presented in the newborn period with cyanosis and cardiomegaly. The remainder (6/17) were referred because of cardiomegaly on chest X-ray and/or a heart murmur heard on routine examination. Three patients have died; one in the newborn period and two suddenly at the age of 11 and 15 years. Thirteen patients have undergone right and left heart cardiac catheterization within the last seven years. Twelve of these 13 patients (92%) had angiocardiographic left ventricular contraction abnormalities. Five patients also had mitral valve prolapse associated with left ventricular dysfunction. Since many patients with Ebstein's anomaly may have significant left ventricular abnormalities, careful and systematic evaluation of the left ventricle is warranted.

Echocardiography in congenital heart disease

The utility of echocardiography in the evaluation of congenital cardiac disease is well established. The following discussion will be devoted to the application of single dimensional equipment in the assessment of selected congenital defects which will include secundum atrial defects, endocardial cushion defects, tetralogy of Fallot, Ebstein's anomaly of the tricuspid valve, and the use of systolic time intervals in assessing pulmonary artery diastolic pressures and pulmonary vasculature resistance. Since space is limited, only brief descriptions of these specific applications are possible and the readers are referred to more complete descriptions of the technic.

Cyanotic congenital heart disease

This review describes the evolving concepts of diagnosis and management of patients with cyanotic congenital heart disease. Early palliative surgical procedures were followed by reparative operations and are now to a large extent replaced by these operations which are designed to relieve the problem. Collaboration of the team of cardiologists, surgeons, radiologists, anesthesiologists and nurses has made the many developments possible. The teamwork has not only widened the scope of what can be accomplished but has also extended the opportunities for beneficial reparative surgery down to the first weeks and months of life. Precise diagnosis and meticulous operative and perioperative care by the team are essential elements of success. Long-term follow-up and regular analyses of results have led to continuing improvements. Although these patients were born to be blue, their color and their outlook have been changed during these last 3 decades to something close to rosy.

Echocardiographic spectrum of Ebstein's anomaly of the tricuspid valve

Sixteen patients aged between one day to 18 years with Ebstein's malformation of the tricuspid valve were studied with ultrasound. The findings were compared with a group of 74 patients without Ebstein's malformation. Two features were considered specific for Ebstein's malformation: 1) ability to record the anterior tricuspid leaflet (ATL) farther to the left of the left sternal border than in the control group; and 2) abnormally prolonged interval between the "C" points of the tricuspid and the mitral valve echoes (McTcI). All other parameters measured were nonspecific for Ebstein's anomaly of the tricuspid valve. The sail sound was recorded in ten patients with Ebstein's malformation and occurred at the time when the anterior tricuspid leaflet was in the most posterior position. In a patient with congenital heart disease, an McTc interval greater than 0.03 sec and recording of an anterior tricuspid leaflet near the apex of the heart strongly suggest the diagnosis of Ebstein's malformation. These two criteria were not fulfilled in any patient who did not have Ebstein's malformation. Conversely, however, absence of these two features does not rule out Ebstein's anomaly of the tricuspid valve.