Clinical study on the abnormal flow patterns in Ebstein's anomaly using pulsed Doppler echocardiography.

Pulsed Doppler echocardiography (PDE) was performed in 10 patients with Ebstein's anomaly and 10 cases of tricuspid regurgitation secondary to mitral stenosis. Distal atrialized right ventricle (ATRV): In all patients with Ebstein's anomaly, tricuspid regurgitation flow was recognized by PDE. In this lesion with moderate tricuspid regurgitation, a widely dispersed dot pattern was recorded during systole However, in the cases with severe tricuspid regurgitation a relatively smooth dot pattern was recognized. In the case with marked delay in pressure rise in the right ventricle, PDE showed a bimodal regurgitant flow pattern. The interval between the onset of QRS and that of tricuspid regurgitant flow with right ventricular pressure rise was measured. The interval corrected for heart rate ranged from 0.10 to 0.35 with an average of 0.19 +/- 0.08 sec. In the subjects with secondary tricuspid regurgitation, it ranged from 0.07 to 0.11 sec. This interval was significantly prolonged in Ebstein's anomaly as compared to that in secondary tricuspid regurgitation (p less than 0.001). Proximal ATRV: Tricuspid regurgitant flow was detected in 6 to 10 patients with Ebstein's anomaly. The disturbed flow was less apparent in the proximal ATRV than in the distal ATRV.