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A new method for evaluating tricuspid valve displacement in children with Ebstein's anomaly: using the annulus and
Guo-Ping Jiang1, Li-Chao Gao, Fang-Qi Gong
1Department of Ultrasonography, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Insights
Echocardiography using the tricuspid valve annulus and coronary sinus as reference points accurately measures leaflet displacement in children with Ebstein
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Congenital Heart Disease
Background:
- Ebstein's anomaly is a congenital heart defect characterized by the downward displacement of the tricuspid valve leaflets.
- Accurate assessment of leaflet displacement is crucial for surgical planning and prognosis.
Purpose of the Study:
- To investigate the tricuspid valve annulus and coronary sinus as reliable reference points for measuring leaflet displacement in pediatric Ebstein's anomaly using echocardiography.
- To correlate echocardiographic findings with surgical measurements.
Main Methods:
- Echocardiography was performed on 25 children diagnosed with Ebstein's anomaly.
- The downward displacement of the posterior and anterior tricuspid valve leaflets was measured using the tricuspid annulus and coronary sinus as reference points.
- Echocardiographic measurements were compared with intraoperative surgical findings.
Main Results:
- The study identified displacement patterns involving septal, posterior, and anterior leaflets in most patients.
- Measured displacement distances for septal and posterior leaflets were 2.08 ± 1.15 cm and 2.58 ± 1.06 cm, respectively.
- Echocardiographic measurements closely correlated with surgical findings, validating the reference points used.
Conclusions:
- The tricuspid valve annulus and coronary sinus serve as ideal reference points for echocardiographic evaluation of tricuspid valve leaflet displacement in Ebstein's anomaly.
- Understanding leaflet displacement, particularly of the anterior leaflet, is critical for assessing tricuspid regurgitation flow direction and guiding treatment.
Abstract:
This study aimed to investigate the reference point for the downward displacement of the posterior and anterior leaflets of the tricuspid valve using echocardiography in children with Ebstein's anomaly. This study enrolled 25 patients with Ebstein's anomaly. The extent of downward displacement of the posterior and anterior leaflets of the tricuspid valve was evaluated by echocardiography using the tricuspid annulus and the coronary sinus as reference points. These results were compared with the surgical findings. The findings showed displacement of the simple septal leaflet in 1 patient, displacement of both the septal and posterior leaflets in 22 patients, displacement of both the anterior and posterior leaflets in 1 patient, and displacement of all the leaflets in 1 patient. Because the septal and posterior leaflets were close to the apex or because the posterior leaflet was nearly absent, the displacement distance of the septal and posterior leaflets could not be measured accurately in two patients. The displacement distance of the septal and posterior leaflets in the remaining 22 patients were 2.08 ± 1.15 and 2.58 ± 1.06 cm, respectively. The displacement distances of the anterior leaflet in two patients were respectively 1.0 and 2.2 cm. These results were similar to those measured during surgery. The direction of the valvular regurgitation flow was anterolateral in the apical four-chamber and apical right heart two-chamber views in patients with the downward displacement of the anterior leaflet. The tricuspid valve annulus and the coronary sinus are ideal reference points for evaluating the downward displacement of the posterior and anterior leaflets of the tricuspid valve. It is critical to evaluate the downward displacement of the anterior leaflet that the direction of the tricuspid regurgitation flow is changed.
