3Dechocardiography
the art of defining cardiac morphology

Abnormalities of the tricuspid Valve

Ebstein's Anomaly of the Tricuspid Valve

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The patho-morphology of Ebstein's malformation include the following,

Displacement of the coaptation point of the right AV valve

Rotational anomaly of the valve leaflets along the axis of the aorta

Failure of delamination of individual leaflets

Valve dysplasia

Abnormalities of tension (subcordal) apparatus

Myocardial abnormalities

Abnormal Function of the right ventricle

Variable abnormalities in the Anatomy and function of the systemic ventricle

Co-existent cardiac anomalies (ASD, VSD, PS)

Cartoon demonstrating the displacement of the right Atrioventricular valve towards the apex of the right ventricle in Ebstein's anomaly. Normal atrioventricular junction is defined by the dotted line. To the right is the 3D reconstruction of the cartoon showing the locus of formation of the tricuspid valve.

3D echocardiographic correlate of valfusion resulting in bifoliate closure of tricuspid valve:

(Specimens from prof Anderson)

Figure below shows fusion between the septal and mural leaflet causing bicuspid closure line.

Severe dysplasia of the subcordal apparutus leading to multipple hyphanated attachments to multipple points on the ventricular wall as shown below.

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Echocardiographic profile of a normal tricuspid valve viewed from the right atria

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2D TOE showing two points of regurgitation from a right AV valve in a patient with Ebsteins.

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This video profiles the abnormality of the tricuspid valve very precisely. The valve has two points of coaptation failures: 1. between the septal and mural leaflets. It almost appears to have an extra leaflet formation at the posterior aspect. 2. There is another point of coaptation failure between the anterio-superior (ASL) and the mural leaflets. Use the pause button to stop and review the abnormality more clearly.

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Demonstration of bifoliate closure of an Ebstein's valve. Displacement of the leaflets and the atrialization of the RV is clear from this longaxis obleque view from the right atria

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Bifoliate clossure line of a tricuspid valve. Here too there are two points of coaptation failure. Note that the septal leaflet is very dysplastic and immobile. This is compensated by the highly mobile antero-superior leaf let. This leaflet has a tethering which leads to a point of coaptation failure between it and the mural leaflet. The mural leaflet itself is well formed but less mobile.

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MPR of a dysplastic tricuspid valve demonstrating the delamination anomaly of both the septal and anterio-superior leaflets.

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Abnormal shelf formation of the ASL in apatient with Ebstein's showing a fixed coaptation failure through which regurgitation ocurs

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Partially removed ASL and both atria and ventricle to just demonstrate the point of coaptation in a patient with Ebstein's where there is both stenosis (abnormal sub-cordal apparatus attachements) and regurgitation (coaptation failure)

Pre and post operative morphology after surgical repair of the Ebstein's anomaly

For related articles please go to,

Eu J Echocardiography 2008,

JTCVS 2008

Back To Heart Defects

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