A New Method for Evaluating Tricuspid Valve Displacement in Children With Ebstein’s Anomaly: Using the Annulus and Coronary Sinus as a Reference Point
A New Method for Evaluating Tricuspid Valve Displacement in Children With Ebstein’s Anomaly: Using the Annulus and Coronary Sinus as a Reference Point
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评估 Ebstein 畸形儿童三尖瓣移位的新方法：以瓣环和冠状窦作为参考点
作者：
Guo;Li;F. Gong;Jin He;Jingjing Ye
本研究旨在探讨Ebstein畸形患儿超声心动图下移三尖瓣后叶和前叶的参考点。这项研究招募了25名患有Ebstein异常的患者。超声心动图以三尖瓣环和冠状窦为参照点，评估三尖瓣后叶和前叶向下移位的程度。这些结果与手术结果进行了比较。结果显示，单侧小叶移位1例，室间隔和后小叶同时移位22例，前后小叶同时移位1例，全部小叶移位1例。由于鼻中隔和后小叶靠近鼻尖或后小叶几乎缺失，两例患者鼻中隔和后小叶的位移距离无法准确测量。其余22例患者鼻中隔和后小叶移位距离分别为2.08±1.15 cm和2.58±1.06 cm。2例患者前小叶移位距离分别为1.0 cm和2.2 cm。这些结果与手术中测量的结果相似。在前小叶向下移位的患者中，心尖四室和右心尖二室的瓣膜返流方向为前外侧。三尖瓣环和冠状窦是评估三尖瓣后叶和前叶向下移位的理想参考点。评估三尖瓣反流方向改变的前小叶向下移位是至关重要的。
This study aimed to investigate the reference point for the downward displacement of the posterior and anterior leaflets of the tricuspid valve using echocardiography in children with Ebstein’s anomaly. This study enrolled 25 patients with Ebstein’s anomaly. The extent of downward displacement of the posterior and anterior leaflets of the tricuspid valve was evaluated by echocardiography using the tricuspid annulus and the coronary sinus as reference points. These results were compared with the surgical findings. The findings showed displacement of the simple septal leaflet in 1 patient, displacement of both the septal and posterior leaflets in 22 patients, displacement of both the anterior and posterior leaflets in 1 patient, and displacement of all the leaflets in 1 patient. Because the septal and posterior leaflets were close to the apex or because the posterior leaflet was nearly absent, the displacement distance of the septal and posterior leaflets could not be measured accurately in two patients. The displacement distance of the septal and posterior leaflets in the remaining 22 patients were 2.08 ± 1.15 and 2.58 ± 1.06 cm, respectively. The displacement distances of the anterior leaflet in two patients were respectively 1.0 and 2.2 cm. These results were similar to those measured during surgery. The direction of the valvular regurgitation flow was anterolateral in the apical four-chamber and apical right heart two-chamber views in patients with the downward displacement of the anterior leaflet. The tricuspid valve annulus and the coronary sinus are ideal reference points for evaluating the downward displacement of the posterior and anterior leaflets of the tricuspid valve. It is critical to evaluate the downward displacement of the anterior leaflet that the direction of the tricuspid regurgitation flow is changed.