© 2014, Wiley Periodicals, Inc. DOI: 10.1111/echo.12599
Echocardiography
Intracardiac Echocardiography of Ebstein’s Anomaly Claire Dauphin, M.D.,* Aur elie Chalard, M.D.,* and Jean-Ren e Lusson, M.D., Ph.D.*,† ^ pital Gabriel Montpied, Service de cardiologie et maladies vasculaires, Clermont*CHU Clermont-Ferrand, Ho Ferrand, France; and †CHU Clermont-Ferrand, Clermont-Ferrand, France
(Echocardiography 2014;31:E232–E233) Key words: Ebstein’s anomaly, intracardiac echocardiography, patent foramen ovale
We report the case of a 9-year-old girl with a severe form of Ebstein’s anomaly.1 At the age of 3 months, she was fitted with a right-modified Blalock–Taussig shunt because of deep hypoxia. When she was 5 years old, the shunt was replaced by bidirectional superior cavopulmonary anastomosis, and during the surgical procedure partial closure of the ostium secundum atrial septal defect (ASD) was performed. At the age of 8, she complained of shortness of breath on exertion and underwent cardiac catheterization to close any residual ASD. The atrial septum and the tricuspid valve were analyzed by intracardiac echocardiography (ICE) using an AcuNav10F probe inserted via the left
A
femoral vein. The ultrasound examination showed almost total closure of the ASD and a clear picture of the anomaly of the tricuspid valve with nondelamination of the septal and posterior leaflets.1,2 Intracardiac echocardiography is not usually used to evaluate Ebstein’s anomaly: indeed, this assessment is done by transthoracic echocardiography. Three-dimensional (3D) live transthoracic echocardiography3 allows a better understanding of tricuspid’s functional anatomy (tethered and nontethered segments) and a more accurate quantification of tricuspid’s regurgitation. Intracardiac echocardiography is an interesting alternative to transesophageal echocardiography for the monitoring of percutaneous closure
B
Figure 1. “Home view” during diastole A. and during systole B. RA = right atrium; ARV = atrialized right ventricle; RV = right ventricle. Address for correspondence and reprint requests: Claire Dauphin, M.D., Pole de cardiologie – CHU Clermont-Ferrand, Hopital Gabriel Montpied, F – 63003 Clermont-Ferrand, France. Fax: +33 4 73 75 19 34; E-mail: [email protected]
E232
Intracardiac Echocardiography of Ebstein’s Anomaly
A
B
Figure 2. Home view: A. attachment of the posterior and septal leaflets of the tricuspid valve (TV), B. detail of the attachment of the posterior leaflet: failure of delimination of the leaflet.
of the ASD.4 In our patient, it clearly evidenced the failure of delamination of the tricuspid valve. These are the first published ICE images of Ebstein’s anomaly (Figs. 1 and 2). References 1. Attenhofer Jost CH, Connolly HM, Dearani JA, et al: Ebstein’s anomaly. Circulation 2007;115:277–285.
2. Houyel L: Ebstein anomaly. Anatomic aspects. Arch Mal Coeur Vaiss 2002;95:513–517. 3. Patel V, Nanda NC, Rajdev S, et al: Live/real time three-dimensional transthoracic echocardiographic assessment of Ebstein’s Anomaly. Echocardiography 2005;22: 847–854. 4. Koenig PR, Abdulla RI, Cao QL, et al: Use of intracardiac echocardiography to guide catheter closure of atrial communications. Echocardiography 2003;20:781–787.
E233
Echocardiography
Intracardiac Echocardiography of Ebstein’s Anomaly Claire Dauphin, M.D.,* Aur elie Chalard, M.D.,* and Jean-Ren e Lusson, M.D., Ph.D.*,† ^ pital Gabriel Montpied, Service de cardiologie et maladies vasculaires, Clermont*CHU Clermont-Ferrand, Ho Ferrand, France; and †CHU Clermont-Ferrand, Clermont-Ferrand, France
(Echocardiography 2014;31:E232–E233) Key words: Ebstein’s anomaly, intracardiac echocardiography, patent foramen ovale
We report the case of a 9-year-old girl with a severe form of Ebstein’s anomaly.1 At the age of 3 months, she was fitted with a right-modified Blalock–Taussig shunt because of deep hypoxia. When she was 5 years old, the shunt was replaced by bidirectional superior cavopulmonary anastomosis, and during the surgical procedure partial closure of the ostium secundum atrial septal defect (ASD) was performed. At the age of 8, she complained of shortness of breath on exertion and underwent cardiac catheterization to close any residual ASD. The atrial septum and the tricuspid valve were analyzed by intracardiac echocardiography (ICE) using an AcuNav10F probe inserted via the left
A
femoral vein. The ultrasound examination showed almost total closure of the ASD and a clear picture of the anomaly of the tricuspid valve with nondelamination of the septal and posterior leaflets.1,2 Intracardiac echocardiography is not usually used to evaluate Ebstein’s anomaly: indeed, this assessment is done by transthoracic echocardiography. Three-dimensional (3D) live transthoracic echocardiography3 allows a better understanding of tricuspid’s functional anatomy (tethered and nontethered segments) and a more accurate quantification of tricuspid’s regurgitation. Intracardiac echocardiography is an interesting alternative to transesophageal echocardiography for the monitoring of percutaneous closure
B
Figure 1. “Home view” during diastole A. and during systole B. RA = right atrium; ARV = atrialized right ventricle; RV = right ventricle. Address for correspondence and reprint requests: Claire Dauphin, M.D., Pole de cardiologie – CHU Clermont-Ferrand, Hopital Gabriel Montpied, F – 63003 Clermont-Ferrand, France. Fax: +33 4 73 75 19 34; E-mail: [email protected]
E232
Intracardiac Echocardiography of Ebstein’s Anomaly
A
B
Figure 2. Home view: A. attachment of the posterior and septal leaflets of the tricuspid valve (TV), B. detail of the attachment of the posterior leaflet: failure of delimination of the leaflet.
of the ASD.4 In our patient, it clearly evidenced the failure of delamination of the tricuspid valve. These are the first published ICE images of Ebstein’s anomaly (Figs. 1 and 2). References 1. Attenhofer Jost CH, Connolly HM, Dearani JA, et al: Ebstein’s anomaly. Circulation 2007;115:277–285.
2. Houyel L: Ebstein anomaly. Anatomic aspects. Arch Mal Coeur Vaiss 2002;95:513–517. 3. Patel V, Nanda NC, Rajdev S, et al: Live/real time three-dimensional transthoracic echocardiographic assessment of Ebstein’s Anomaly. Echocardiography 2005;22: 847–854. 4. Koenig PR, Abdulla RI, Cao QL, et al: Use of intracardiac echocardiography to guide catheter closure of atrial communications. Echocardiography 2003;20:781–787.
E233
