Ebsteins anomaly of the tricuspid valve echocardiography or ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] and Claudia P. Hochberg, M.D. [2]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]}; Keri Shafer, M.D. [4] Priyamvada Singh, MBBS [[5]]

Assistant Editor-In-Chief: Kristin Feeney, B.S. [[6]]

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

Findings on echo are-

• Apical displacement of the anterior tricuspid valve leaflet as shown below. At the arrow you can see the tricuspid valve apparatus displaced towards the RV apex which is upward in the picture.

• '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:

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Limitations of Echocardiography

There may be inadequate views or windows to fully assess the tricuspid valve, and in this case an MRI is the next appropriate Test