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Patient presented with chest pain and difficulty of breathing. Physical examination revealed a murmur.
The patient had a 2D echocardiogram which revealed the following findings:
Atrialized right ventricle with normal systolic function. Slightly thickened ventricular walls. There is flattening of the interventricular septum indicative of pressure overload. Tethered and apically displaced septal leaflet of the tricuspid valve (Apical displacement indexed= 18 mm/m²). The anterior leaflet is also tethered with Sail-like sign. Non-coaptation of all the leaflets resulting to severe regurgitation. Tricuspid regurgitation Vmax = 3.5 m/s; Peak gradient = 48 mmHg. Findings are consistent with Ebstein Anomaly
Small left ventricular size (left ventricular end-diastolic diameter indexed to body surface area = 2.1 cm/m²). Mild systolic dysfunction. Ejection fraction by visual estimation: 50-55%. Normal filling pressure.
Normal left atrial size. Area = 8 cm². Interatrial septum appears to be intact by color Doppler
Severely dilated right atrial size. Area = 105 cm². Dilated inferior vena cava with <50% collapsibility. Estimated right atrial pressure= > 15 mmHg
Thickened mitral valve leaflets without restriction of motion. Moderate regurgitation
Thickened aortic cusps without restriction of motion. No regurgitation
Normal pulmonic valve. Mild regurgitation. Right ventricular outflow tract VTI = 12 cm
Normal aortic root diameter
Dilated main pulmonary artery dimensions
No pericardial effusion
Moderately elevated pulmonary pressures
This is a case of an adult patient with echocardiographically proven Ebstein anomaly.
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