Ebstein’s anomaly of the tricuspid valve Physical examination Clinical features and Treatment

Ebstein’s anomaly of the tricuspid valve Ebstein’s anomaly Physical examination with Clinical features

  • Ebsetin’s anomaly of the tricuspid valve is a congeni­tal heart disease in which the tricuspid valve is placed at a lower level so that there is atrialization of the rigFit ventricle.
  • A congenital heart condition resulting from downward displacement of the tricuspid valve from the anulus fibrosus. It causes fatigue, palpitations, and dyspnea.
  • Abnormal downward placement of tricuspid valve within the RV; tricuspid regurgitation, hypoplasia of RV, and a right-to-left shunt are common
  • There is a downward displacement of the tricuspid valve into the right ventricle due to anomalous at­. achment of tricuspid leaflets.

Clinical features  of Ebstein’s anomaly of the tricuspid valve

  • Ebsetin’s anomaly of the tricuspid valve cyanosis ay or may not be present.
  • ulmonary vascularity is normal or reduced. left ventricle is dominant.
  • here may be transient neonatal cyanosis with recur­-ence years later.
  • cyanosis is present in the neonatal age infant is achypneic and prognosis is bad.
  • there is earl systolic decrescendo murmur of TR best eard in the tricuspid area.
  • 3rd and 4th heart sounds are present resulting in a triple or quadruple rhythm.
  • left ventricular impulse is seen
  • VP is normal
  • jrst heart sound is widely split and TI is loud
  • there is short mid-diastolic, presystolic murmur.

Ebstein's anomaly 1

Ebstein’s anomaly of the tricuspid valve Ebstein’s anomaly Physical examination with Clinical features

Ebstein’s anomaly Physical examination —

  • The last finding represents passive hepatic congestion resulting from tricuspid regurgitation and elevated right atrial pressure.
  • The physical findings vary with the severity of pathology and the magnitude of right-to-left interatrial shunting.
  • A systolic murmur from tricuspid regurgitation is a common finding
  • When tricuspid regurgitation is severe, jugular venous distension and a prominent “v” wave may be seen

ECG

  • shows tall, broad, right atrial P waves in V1, increased PR interval, right bundle block branch dee
  • aves in L2, 3, aVF and Vl V2.

 X-ray

  • decreased pulmonary vascularity, small aortic t and pulmonary trunk and large right atrium.
  • In severe cases, the chest radiograph reveals massive cardiomegaly (often termed a “wall to wall” heart) with diminished pulmonary vascularity
  • In a neonate the cardiac silhouette occupies the en­tire chest.
  • The chest radiograph may be normal in patients with less severe disease.

2D echo

  • Echocardiography shows apical displacement of tricuspid septal leaflet, abnormal RV size, and quantitates degree of tricuspid regurgitation.
  • Shows leaflet abnormalities, atrialized right ventricle, paradoxical septal motion, tricuspid regurgitation, enlarged left ventricle and right-to- left shunt via atrial septal defect.

Treatment of Ebstein’s anomaly

  • Prosthetic tricuspid valve may be surgically implanted.