Author + information
- Received November 12, 1985
- Revision received February 10, 1986
- Accepted April 4, 1986
- Published online September 1, 1986.
- Petros Nihoyannopoulos, MD*,1,
- William J. McKenna, MD, FACC1,
- Gillian Smith, BSc1 and
- Rodney Foale, MRCP, FACC1
- ↵*Address for reprints: Petros Nihoyannopoulos, MD, Royal Postgraduate Medical School, Department of Medicine (Clinical Cardiology), Hammersmith Hospital, London, W12 OHS England.
Two-dimensional echocardiography was performed in 16 patients with Ebstein's anomaly to assess right ventricular anatomy and function in relation to clinical features and prognosis. Measurements of right ventricular anatomy and function were established in 10 normal subjects for comparison. Ten patients were in New York Heart Association functional class I, four in class II and one each in classes III and IV. Right ventricular morphology and the three tricuspid valve leaflets were assessed from right ventricular inflow tract and apical four chamber views. The anterior tricuspid leaflet was abnormal but not displaced in all patients; the septal and posterior leaflets were displaced in 14 (88%) and 11 (69%) patients respectively. The posterior leaflet was best visualized from the right ventricular inflow tract, and in two patients this view was required for the echo-cardiographic diagnosis of Ebstein's anomaly, based on displacement of the septal tricuspid valve leaflet.
An index of right ventricular function, the fractional area contraction, was defined as the difference between the end-diastolic and the end-systolic area, normalized to the end-diastolic area. This index was calculated for both the proximal (atrialized) right ventricle and the total right ventricle. Total right ventricular end-diastolic area and fractional area contraction exceeded 95% confidence limits when compared with values in the normal group. During a median follow-up period of 4 years three patients died. They had severe right heart morphologic or functional abnormalities; two were in functional class III or IV and one was asymptomatic. None of the survivors had severe symptoms. Eight survivors had mild morphologic or functional abnormalities of the tricuspid valve or right ventricle, whereas five others including one patient with absent septal leaflet had paradoxic systolic expansion of the proximal right ventricular chamber.
Thus, in these patients with Ebstein's anomaly there was no correlation between clinical status, including the occurrence of arrhythmias or sudden death, and the severity of morphologic and functional abnormalities of the right ventricle. This suggests that other factors, particularly electrical instability, may be important.
- Received November 12, 1985.
- Revision received February 10, 1986.
- Accepted April 4, 1986.
- American College of Cardiology Foundation