Ebsteins anomaly of the tricuspid valve echocardiography or ultrasound: Difference between revisions
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{{Template:Ebstein's anomaly of the tricuspid valve}} | {{Template:Ebstein's anomaly of the tricuspid valve}} | ||
{{CMG}} | {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; [[Priyamvada Singh|Priyamvada Singh, MBBS]] [mailto:psingh13579@gmail.com]; 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 | |||
*Identifying the lesion | |||
*Determining the severity of dilatation of the [[right atrium]] | *Determining the severity of dilatation of the [[right atrium]] | ||
*Finding other associated cardiac defects that may be present | *Finding other associated [[cardiac]] defects that may be present | ||
*Finding the functional status of the [[tricuspid valve]] as well as the [[right ventricle]] | *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 echocardiography|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 | 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 valves|tricuspid valve]]. Note substantial [[tricuspid regurgitation]], which originates close to the apex, where the abnormal leaflets actually coapt: | |||
{{#ev:youtube|KEko3kM26bY}} | |||
{{#ev:youtube|nP4akONmaVE}} | |||
==ACC/AHA 2018 Guidelines for the Diagnostic recommendations of Adults With Ebstein Anomaly(DO NOT EDIT)<ref name="pmid30121239">{{cite journal |vauthors=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 |title=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 |journal=J. Am. Coll. Cardiol. |volume=73 |issue=12 |pages=e81–e192 |date=April 2019 |pmid=30121239 |doi=10.1016/j.jacc.2018.08.1029 |url=}}</ref><ref name="StoutDaniels2019">{{cite journal|last1=Stout|first1=Karen K.|last2=Daniels|first2=Curt J.|last3=Aboulhosn|first3=Jamil A.|last4=Bozkurt|first4=Biykem|last5=Broberg|first5=Craig S.|last6=Colman|first6=Jack M.|last7=Crumb|first7=Stephen R.|last8=Dearani|first8=Joseph A.|last9=Fuller|first9=Stephanie|last10=Gurvitz|first10=Michelle|last11=Khairy|first11=Paul|last12=Landzberg|first12=Michael J.|last13=Saidi|first13=Arwa|last14=Valente|first14=Anne Marie|last15=Van Hare|first15=George F.|title=2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease|journal=Journal of the American College of Cardiology|volume=73|issue=12|year=2019|pages=e81–e192|issn=07351097|doi=10.1016/j.jacc.2018.08.1029}}</ref>== | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | |||
|- | |||
|bgcolor="LemonChiffon" |<nowiki></nowiki>'''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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | |||
''<nowiki/>'' | |||
|} | |||
==References== | ==References== | ||
{{Reflist}} | {{Reflist}} | ||
{{Congenital malformations and deformations of circulatory system}} | {{Congenital malformations and deformations of circulatory system}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Cardiovascular system]] | |||
[[Category:Cardiology]] | |||
[[Category:Congenital heart disease]] | |||
[[Category:Pediatrics]] | |||
[[Category:Disease]] | |||
Latest revision as of 18:32, 12 February 2020
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Ebsteins anomaly of the tricuspid valve Microchapters | |
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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:
{{#ev:youtube|KEko3kM26bY}}
{{#ev:youtube|nP4akONmaVE}}
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.