Ebsteins Anomaly

Case Management Zahir Rahman 4.12.04

H & P ,[object Object],[object Object],[object Object],[object Object]

H & P ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Physical Exam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Echo ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

W sign: direct atrial to ventricular conduction seen with accessory bypass tracts

Atrial PES generating orthodromic tachycardia Refractory accessory bypass tract and conduction through AV node to generate tachycardia

Ebstein’s Anomaly of the Tricuspid Valve

Ebstein’s Anomaly ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Graham TP et al. Roberts Congenital Heart Disease in adults. Complex cyanotic heart disease in adults: 395-99.

Ebstein’s Anomaly ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Ferencz et al. Ebsteins malformation of the tricuspid valve: genetic and environmental factors. The Baltimore-Washington Infant Study Group. Teratology 1994;50:137-47.

Ebstein’s Anomaly ,[object Object],[object Object],[object Object],[object Object],[object Object],1. Freedom RM et al. Topol Textbook of CV Medicine. Congenital Heart Disease: Chapter 30. 2. Friedman WF et al. Braunwald Heart Disease. Congenital Heart Diesease: Chapter 43.

Ebstein’s anomaly and distal linear attachments A: Moderate displacement of septal and posterior leaflets ( closed arrow ) with mobile anterior leaflet ( open arrow ). B: Marked displacement of septal and posterior leaflets with mobile anterior leaflet C: Nonmobile anterior leaflet with chordal tethering ( arrows ) to ventricle D: Severely stenotic or imperforate Ebstein’s anomaly ( arrows ). Freedom RM et al. Topol Textbook of CV Medicine. Congenital Heart Disease: Chapter 30.

Carpentier’s Classification ,[object Object],[object Object],[object Object],[object Object]

Ebstein’s Anomaly : Clinical Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ebstein’s: Associated Anomalies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Freedom RM et al. Topol Textbook of CV Medicine. Congenital Heart Disease: Chapter 30.

Ebsteins: Clinical Presentation and outcome ,[object Object],[object Object],Celermajer et al. Ebstein’s anomaly: presentation and outcome from fetus to adult. JACC 1994;23:170-6.

Ebstein’s: MC presentation in each age group ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Celermajer et al. Ebstein’s anomaly: presentation and outcome from fetus to adult. JACC 1994;23:170-6.

Ebstein’s Celermajer et al. Ebstein’s anomaly: presentation and outcome from fetus to adult. JACC 1994;23:170-6 .

Ebstein’s: outcome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Celermajer et al. Ebstein’s anomaly: presentation and outcome from fetus to adult. JACC 1994;23:170-6.

Ebsteins: Physical exam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Friedman WF et al. Braunwald Heart Disease. Congenital Heart Diesease: Chapter 43.

Ebstein’s: CXR ,[object Object],[object Object],[object Object],[object Object],Friedman WF et al. Braunwald Heart Disease. Congenital Heart Diesease: Chapter 43.

Ebstein’s: EKG ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1. Graham TP et al. Roberts Congenital Heart Disease in adults. Complex cyanotic heart disease in adults: 395-99. 2. Bialostozky et al. Ebstein’s malformation of tricuspid valve. Am. J. Cardiology. 1972:29;826. 3. Friedman WF et al. Braunwald Heart Disease. Congenital Heart Diesease: Chapter 43.

Ebstein’s : WPW ,[object Object],[object Object],[object Object],[object Object],Graham TP et al. Roberts Congenital Heart Disease in adults. Complex cyanotic heart disease in adults: 395-99.

Ebsteins: Catheterization ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Graham TP et al. Roberts Congenital Heart Disease in adults. Complex cyanotic heart disease in adults: 395-99.

Ebsteins - echocardiography ,[object Object],[object Object],[object Object],[object Object],Friedman WF et al. Braunwald Heart Disease. Congenital Heart Diesease: Chapter 43.

Ebsteins: Echo ,[object Object],Shina et al. 2D echocardiographic spectrum of Ebsteins anomaly: Detailed anatomic assessment. JACC 1984: 3.

Ebstein’s: Echocardiographic Severity index ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Celermajer et al. Outcome in neonates with Ebstein’s anomaly. JACC 1992; 19:1047-8.

Recommendations for Diagnostic Evaluation of Ebstein’s Anomaly in the Adolescent or Young Adult ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],BONOW ET AL., ACC/AHA TASK FORCE REPORT JACC Vol. 32, No. 5, November 1998:1486-1588 ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease

Ebstein’s: Medical Care ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Recommendations for Surgery in the Adolescent or Young Adult with Ebstein’s Anomaly with Severe Tricuspid Regurgitation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],BONOW ET AL., ACC/AHA TASK FORCE REPORT JACC Vol. 32, No. 5, November 1998:1486-1588 ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease

Ebstein’s: Surgery ,[object Object],[object Object],[object Object],[object Object],Cardiothoracic Surgery. www.ctsnet.org

Ebstein’s: Surgery ,[object Object],[object Object],Cardiothoracic Surgery. www.ctsnet.org

Ebstein’s: Surgery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Renfu et al. Experience in corrective surgery for Ebstein’s anomaly in 139 patients. J Heart Valve Dis 2001;10:396-8.

Ebstein’s: Outcomes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ebstein’s Anomaly: Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ebsteins Anomaly

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