ECHOCARDIOGRAPHIC DIAGNOSIS OF EBSTEIN ANOMALY

. This study examined the value of echocardiography in the diagnosis of Ebstein anomaly using data collected from 12 patients with Ebstein anomaly. These patients were hospitalized between March 2015 – October 2019 in the department of paediatric cardiac surgery in Timofei Moșneaga Clinical Their pre-operative echocardiography description of the tricuspid valve and the description of the surgeon from the surgery were compared. Results showed that the data obtained by echocardiography were very similar to the intraoperative findings that were reported by the surgeon in most patients.


Fig. 1 :Tricuspid valve delamination [3]
The right ventricle is thus divided into 2 parts by the abnormal tricuspid valve: The first, thin walled "atrialized" portion, is continues with the cavity of the right atrium. The second, often smaller portion is consists of normal ventricular myocardium ( Fig. 2) [2]. The right atrium is enlarged due to tricuspid regurgitation, although the degree is extremely variable. In more severe forms of Ebstein anomaly the effective output from the right side of the heart is decreased due to combination of the poorly functioning small right ventricle, tricuspid valve regurgitation, and obstruction of the right ventricle by the large sail-like anterior tricuspid valve leaflet [2].
Ebstein anomaly is the only congenital heart lesion that has a range of clinical presentations, from the severely symptomatic neonate to an asymptomatic adult [5].
The prognosis varies with the severity of the disease, although an early accurate diagnosis, as well as the advances in diagnostic and surgical techniques and postoperative care has led to improvements in outcome.
Timely diagnosis of a patient with Ebstein anomalywill allow to treat and operate (if needed) in time-preventing possible irreversible heart damage and different complications, which in turn will improve the clinical condition of the patient and his prognosis.
Aim: To evaluate the value of echocardiography in the diagnosis of Ebstein anomaly.
Objective: Compare the echocardiography reports, with intraoperative findings reported by the surgeon.

MATERIALS AND METHODS:
In this study participated 12 patients with Ebstein anomaly who were These parameters from the echocardiography findings were compared to the operative reports that were written by the surgeon (from those who had surgery during the current hospitalization).
Among the 12 patients from the study -9 patients had surgery: 4 of them underwent tricuspid valve repair, 4 had tricuspid valve replacement, and 1 had Glenn procedure (bi-directional cavopulmonary anastomosis).
Among the 9 patients who were operated -7 of them were operated during the current hospitalization, and 2 of them were operated in the pastbefore the current hospitalization in Timofei Moșneaga Republican Clinical Hospital.

General data about the patients included in the study:
General data about the patients are presented in Table 1:

Comparison of description of the tricuspid valve from the pre-operative echocardiography, and the description in the operative report:
In order to evaluate the value of echocardiography in the diagnosis of Ebstein anomaly and to assess its ability to accurately determine the morphology of the tricuspid valve, the pre-operative echocardiography description and the description from the operative reports were compared.
The comparison between the data about the morphology of the tricuspid valve from the echocardiography reports, with the intraoperative findings reported by the surgeon, is presented in table 2:  Among the 12 patients that participated in the study -7 underwent surgery during the current hospitalization.
The preoperative echocardiography results of 72% of them were compatiblewith almost the same findings as was described later by the surgeon in the operative report. (5/7) However, the preoperative echocardiography results of 28% of them (2/7) have shown to be significantly different from the operative report that was described by the surgeon.
In patient number 1the echocardiography results describe a displacement of the septal cusp by 50 mm, whereas the operative report describes a displacement of the septal and anterior cusp by only 10 mm.
In patient number 9 -there is also a difference between the preoperative echocardiography and the operative report. The surgeon described a rupture of the anterior cusp's cords, which was not mentioned in the preoperative echocardiography report.

CONCLUSION:
The data obtained by echocardiography are compatible, and very similar to the intraoperative findings that were reported by the surgeon.