| Abstract (Part1)Diagnosis of Ebstein’s Anomaly with Conventional and Real-time Three-dimensional Transthoracic EchocardiographyObjective:To explore the value of conventional echocardiography and transthoracic real-time three-dimensional echocardiography(RT3DE) in diagnosis of Ebstein’s anomaly.Methods:We investigated the morphology and function of right ventricle as well as the structure, morphology and regurgitation of tricuspid valve in 61 adult patients with Ebstein’s anomaly before surgery by using conventional transthoracic echocardiography and transthoracic RT3DE. Twenty normal adults were enrolled as control group.Results:The surface(en face) of the tricuspid leaflets, the morphology of the tricuspid annulus as well as the three-dimensional structure of the tricuspid valve were displayed stereoscopically by transthoracic RT3DE. Complete right ventricular volume data could be acquired in 32 patients of Ebstein’s anomaly. The apex or part of right ventricle could not be contained in the remaining 29 patients. Thirty-four (55.7%) patients with Ebstein’s anomaly had severe tricuspid regurgitation,16(26.2%) patients had moderate to severe regurgitation, and 11 (18.1%) patients had moderate regurgitation by conventional echocardiography. Compared with the normal adults, patients of Ebstein’s anomaly showed higher right ventricular end-diastolic volume(EDV), end-systolic volume(ESV), end-diastolic volume index(EDVI), end-systolic volume index (ESVI), stroke volume(SV), right ventricle anterior-posterior diameter(RV), tricuspid valve annular transverse diameter (TV-D), and lower right ventricular ejection fraction(EF)(all p<0.05).The tricuspid effective regurgitant orifice area(EROA) were correlated positively with RV(r=0.691), the ratio of right ventricular and left ventricular anterior-posterior diameter(RV/LV) (r=0.6471).Conclusions:Transthoracic RT3DE is a feasible method in addition to conventional two-dimensional echocardiography in evaluation of tricuspid valve mophology and function, as well as right ventricular volume and EF in adult patients with Ebstein anomaly.Abstract (Part2)Evaluation of Cardiac Geometry/Shape and Tricuspid Function in Patients with Ebstein’s Anomaly by EchocardiographyObjective:To evaluate cardiac geometry/shape and tricuspid function in patients with Ebstein’s anomaly by echocardiography.Methods:Twenty patients of Ebstein’s anomaly were enrolled in this study. Routine echocardiography was used to observe shape and attachment of the tricuspid valve. Transverse diameter and area of the left ventricle (LV) and right ventricle (RV), transvers diameter of left atrium (LA) and right atrium (RA), area of atrialized RV, area of functional RV were measured. Rate of ventricular area change, diameter ratio and area ratio of RV to LV, diameter ratio and area ratio of RA to LA were calculated. Tricuspid regurgitation (TR) was assessed by measuring diastolic peak velocity, systolic peak velocity, systolic peak pressure, area of regurgitation, and severity of TR. Great Ormond Street Echo (GOSE) score was calculated.Results: ①The septal and posterior leaflets of the tricuspid valve were displaced towards the apex of RV. M-A/T-A ratio (M-A:distance from the hinge point of the mitral anterior leaflet to the apex of RV; T-A:distance from the hinge point of the tricuspid septal leaflet to the apex) was enlarged. Displacement of the tricuspid anterior leaflet was observed in one case.② Atrialized RV took (58±11)% of total RV area. GOSE score ranged from 0.38 to 1.43, with the average value of 0.87±0.22. One case was GOSE grade 1,14 cases were grade 2, and 5 cases were grade 3. Systolic function of both LV and RV were reduced. ③ Tricuspid regurgitation was observed in these patients, with 6 cases of moderate TR,3 cases of moderate-to-severe TR,11 cases of severe TR. TR area was (32±13) cm2, accounting for (58±17)% of the sum of the area of real RA and aRV.④ Patent foramen ovale was found in 9 cases, and atrial septal defect(ASD) was found in 4 cases.Conclusions:There are abnormalities of cardiac geometry and valular function in patients with Ebstein’s amonaly. We can evaluate geometric and functional changes of both the right heart and the left heart by echocardiography, and help plan surgeries and make prognosis for the disease.Abstract (Part 3)Echocardiographic Evaluation of Short-term Outcomes of Surgical Treatment for Ebstein’s Anomaly above 12 Years of Age in Adolescents and AdultsObjective:To study the value of echocardiographic evaluation in pre and post operation of Ebstein’s anomaly above 12 years of age in adolescents and adults.Methods:We described our experience in using echocardiography in the assessment of 58 patients with Ebstein’s anomaly above 12 years of age in adolescents and adults retrospectively. The level of displacement of the tricuspid apparatus, the size of right ventricle and left ventricle, the size of the tricuspid annular diameter, the severity of tricuspid regurgitation were evaluated. All patients were followed up by echocardiog raphy, and the data of preoperation were compared with that of postoperation.Results:Preoperatively, these changes included a downward displacement of the hinge point of the posterior and septal leaflets, enlarged right atria and right ventricles and a severe preoperative tricuspid regurgitation (TR, grade 3 to 5). Postoperatively TR was significantly reduced(TR, grade 0 to2), and the enlargement in tricuspid valve annulus returned to normal.Conclusions:Echocardiography is useful in accurate diagnosis of the Ebstein’s anomaly preoperationly, showing the morphology of the valve leaflets, and the severity of tricuspid regurgitation. Postoperationly, echocardiography were able to identify surgical effect in Ebstein’s anomaly above 12 years of age in adolescents and adults.
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