Simultaneous closure of the tricuspid and mitral valve in Ebstein's anomaly

Echocardiographic studies of a 23-year-old man with Ebstein's anomaly and type B Wolff-Parkinson-White syndrome showed almost simultaneous closure of the tricuspid and mitral valve. After administration of edrophonium chloride, the tricuspid valve closed 20 msec earlier than the mitral valve. However, the closure of the mitral valve preceded that of the tricuspid valve after administration of ajmaline and atropine sulfate by 90 msec and 60 msec, respectively, concomitant with obliteration of preexcitation. From these observations, the simultaneous closure of the tricuspid and mitral valve of this case appears to depend on the preexcitation of the right ventricle.