Skip to main content

Abstract

Ebstein anomaly is a relatively rare lesion, which represents less than 1 % of all cases of congenital heart disease and has a prevalence of about 3–5 per 100,000 live births. Although Ebstein anomaly primarily relates to a malformation of the tricuspid valve with consequent effects on right ventricular development, there is, in fact, a wide variation of abnormalities and associated lesions which may have significant impact on disease prognosis. Ebstein anomaly is unique in that there is a broad spectrum of disease, varying from the severe neonatal form which continues to carry a dismal prognosis, even in contemporary series, to the milder form which may only become manifest in adult life, if at all.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Samanek M, Voriskova M. Congenital heart disease among 815,569 children born between 1980 and 1990 and their 15-year survival: a prospective bohemia survival study. Pediatr Cardiol. 1999;20:411–7.

    Article  CAS  PubMed  Google Scholar 

  2. Correa-Villasenor A, Ferencz C, Neill CA, Wilson PD, Boughman JA. Ebstein’s Malformation of the tricuspid valve: genetic and environmental factors. The baltimore-washington infant study group. Teratology. 1994;50:137–47.

    Article  CAS  PubMed  Google Scholar 

  3. Zuberbuhler JR, Allwork SP, Anderson RH. The spectrum of Ebstein’s anomaly of the tricuspid valve. J Thorac Cardiovasc Surg. 1979;77:202–11.

    CAS  PubMed  Google Scholar 

  4. Seward JB. Ebstein’s anomaly: ultrasound imaging and hemodynamic evaluation. Echocardiography. 1993;10:641–64.

    Article  Google Scholar 

  5. Edwards WD. Embryology and pathologic features of Ebstein’s anomaly. Prog Pediatr Cardiol. 1993;2:5–15.

    Article  Google Scholar 

  6. Ueber einen sehr seltenen Fall von Insuffizienz der Valvula tricuspidalis, bedingt durch eine angeborene hochgradige Missbildung derselben. Arch. Anat. Physiol. 1866;33:238–55.

    Google Scholar 

  7. Freedom RM, Mawson JB, Yoo SJ, Benson LN. Ebstein’s malformation of the tricuspid valve, in Congenital Heart Disease: Textbook of Angiography, Armonk, NY: Futura Publishing Co, 1997;349–66.

    Google Scholar 

  8. Attie F, Rosas M, Rijlaarsdam M, Buendia A, Zabal C, Kuri J, Granados N. The adult patient with Ebstein anomaly. Outcome in 72 unoperated patients. Medicine. 2000;79:27–36.

    Article  CAS  PubMed  Google Scholar 

  9. Celermajer DS, Cullen S, Sullivan ID, Spiegelhalter DJ, Wyse RK, Deanfield JE. Outcome in neonates with Ebstein’s anomaly. J Am Coll Cardiol. 1992;19:1041–6.

    Article  CAS  PubMed  Google Scholar 

  10. Celermajer DS, Bull C, Till JA, Cullen S, Vassillikos VP, Sullivan ID, Allan L, Nihoyannopoulos P, Somerville J, Deanfield JE. Ebstein’s anomaly: presentation and outcome from fetus to adult. J Am Coll Cardiol. 1994;23:170–6.

    Article  CAS  PubMed  Google Scholar 

  11. Celermajer DS, Dodd SM, Greenwald SE, Wyse RK, Deanfield JE. Morbid anatomy in neonates with Ebstein’s anomaly of the tricuspid valve: pathophysiologic and clinical implications. J Am Coll Cardiol. 1992;19:1049–53.

    Article  CAS  PubMed  Google Scholar 

  12. Yalonetsky S, Tobler D, Greutmann M, Crean AM, Wintersperger BJ, Nguyen ET, Oechslin EN, Silversides CK, Wald RM. Cardiac magnetic resonance imaging and the assessment of Ebstein anomaly in adults. Am J Cardiol. 2011;107:767–73.

    Article  PubMed  Google Scholar 

  13. Lee CM, Sheehan FH, Bouzas B, Chen SS, Gatzoulis MA, Kilner PJ. The shape and function of the right ventricle in Ebstein’s anomaly. Int J Cardiol. 2013;167(3):704–10. doi:10.1016/j.ijcard.2012.03.062.

    Google Scholar 

  14. Fratz S, Janello C, Muller D, Seligmann M, Meierhofer C, Schuster T, Schreiber C, Martinoff S, Hess J, Kuhn A, Vogt M, Stern H. The functional right ventricle and tricuspid regurgitation in Ebstein’s anomaly. Int J Cardiol. 2013;167(1):258–61. doi:10.1016/j.ijcard.2011.12.081.

    Google Scholar 

  15. Tobler D, Yalonetsky S, Crean AM, Granton JT, Burchill L, Silversides CK, Wald RM. Right heart characteristics and exercise parameters in adults with Ebstein anomaly: new perspectives from cardiac magnetic resonance imaging studies. Int J Cardiol. 2013;165(1):146–50. doi:10.1016/j.ijcard.2011.08.004.

  16. Danielson GK, Driscoll DJ, Mair DD, Warnes CA, Oliver Jr WC. Operative treatment of Ebstein’s anomaly. J Thorac Cardiovasc Surg. 1992;104:1195–202.

    CAS  PubMed  Google Scholar 

  17. Allwork SP, Bentall HH, Becker AE, Cameron H, Gerlis LM, Wilkinson JL, Anderson RH. Congenitally corrected transposition of the great arteries: morphologic study of 32 cases. Am J Cardiol. 1976;38:910–23.

    Article  CAS  PubMed  Google Scholar 

  18. Silverman NH, Gerlis LM, Horowitz ES, Ho SY, Neches WH, Anderson RH. Pathologic elucidation of the echocardiographic features of Ebstein’s malformation of the morphologically tricuspid valve in discordant atrioventricular connections. Am J Cardiol. 1995;76:1277–83.

    Article  CAS  PubMed  Google Scholar 

  19. Anderson KR, Danielson GK, McGoon DC, Lie JT. Ebstein’s anomaly of the left-sided tricuspid valve: pathological anatomy of the valvular malformation. Circulation. 1978;58:I87–91.

    Article  CAS  PubMed  Google Scholar 

  20. Horvath P, Szufladowicz M, de Leval MR, Elliott MJ, Stark J. Tricuspid valve abnormalities in patients with atrioventricular discordance: surgical implications. Ann Thorac Surg. 1994;57:941–5.

    Article  CAS  PubMed  Google Scholar 

  21. Oechslin E. Physiologically ‘Corrected’ Transposition of the Great Arteries, in Echocardiography in Pediatric and Congenital Heart Disease: from Fetus to Adult (eds Lai WW, Mertens LL, Cohen MS, Geva T) Wiley-Blackwell, 2009;439–55.

    Google Scholar 

  22. Attenhofer Jost CH, Connolly HM, O’Leary PW, Warnes CA, Tajik AJ, Seward JB. Left heart lesions in patients with Ebstein anomaly. Mayo Clin Proc. 2005;80:361–8.

    Article  PubMed  Google Scholar 

  23. Sedmera D, Pexieder T, Vuillemin M, Thompson RP, Anderson RH. Developmental patterning of the myocardium. Anat Rec. 2000;258:319–37.

    Article  CAS  PubMed  Google Scholar 

  24. Khositseth A, Danielson GK, Dearani JA, Munger TM, Porter CJ. Supraventricular tachyarrhythmias in Ebstein anomaly: management and outcome. J Thorac Cardiovasc Surg. 2004;128:826–33.

    Article  PubMed  Google Scholar 

  25. Hebe J. Ebstein’s anomaly in adults. Arrhythmias: diagnosis and therapeutic approach. Thorac Cardiovasc Surg. 2000;48:214–9.

    Article  CAS  PubMed  Google Scholar 

  26. Yetman AT, Freedom RM, McCrindle BW. Outcome in cyanotic neonates with Ebstein’s anomaly. Am J Cardiol. 1998;81:749–54.

    Article  CAS  PubMed  Google Scholar 

  27. Wald RM, Adatia I, Van Arsdell GS, Hornberger LK. Relation of limiting ductal patency to survival in neonatal Ebstein’s anomaly. Am J Cardiol. 2005;96:851–6.

    Article  PubMed  Google Scholar 

  28. Bove EL, Hirsch JC, Ohye RG, Devaney EJ. How I manage neonatal Ebstein’s anomaly. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2009:63–5.

    Google Scholar 

  29. Kempny A, Dimopoulos K, Uebing A, Moceri P, Swan L, Gatzoulis MA, Diller GP. Reference values for exercise limitations among adults with congenital heart disease. Relation to activities of daily life–single centre experience and review of published data. Eur Heart J. 2012;33:1386–96.

    Article  PubMed  Google Scholar 

  30. MacLellan-Tobert SG, Driscoll DJ, Mottram CD, Mahoney DW, Wollan PC, Danielson GK. Exercise tolerance in patients with Ebstein’s anomaly. J Am Coll Cardiol. 1997;29:1615–22.

    Article  CAS  PubMed  Google Scholar 

  31. Baumgartner H, Bonhoeffer P, De Groot NM, de Haan F, Deanfield JE, Galie N, Gatzoulis MA, Gohlke-Baerwolf C, Kaemmerer H, Kilner P, Meijboom F, Mulder BJ, Oechslin E, Oliver JM, Serraf A, Szatmari A, Thaulow E, Vouhe PR, Walma E, Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of Cardiology, Association for European Paediatric Cardiology, ESC Committee for Practice Guidelines. Esc guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J. 2010;31:2915–57.

    Article  PubMed  Google Scholar 

  32. Boston US, Dearani JA, O’Leary PW, Driscoll DJ, Danielson GK. Tricuspid valve repair for Ebstein’s anomaly in young children: a 30-year experience. Ann Thorac Surg. 2006;81:690–5; discussion 695–6.

    Article  PubMed  Google Scholar 

  33. da Silva JP, da Silva Lda F. Ebstein’s anomaly of the tricuspid valve: the cone repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2012;15:38–45.

    Article  PubMed  Google Scholar 

  34. Attenhofer Jost CH, Connolly HM, Scott CG, Burkhart HM, Warnes CA, Dearani JA. Outcome of cardiac surgery in patients 50 years of age or older with Ebstein anomaly: survival and functional improvement. J Am Coll Cardiol. 2012;59:2101–6.

    Article  PubMed  Google Scholar 

  35. Brown ML, Dearani JA, Danielson GK, Cetta F, Connolly HM, Warnes CA, Li Z, Hodge DO, Driscoll DJ, Mayo Clinic Congenital Heart Center. The outcomes of operations for 539 patients with Ebstein anomaly. J Thorac Cardiovasc Surg. 2008;135:1120–36. 1136.e1121–7.

    Article  PubMed  Google Scholar 

  36. Chauvaud S, Fuzellier JF, Berrebi A, Lajos P, Marino JP, Mihaileanu S, Carpentier A. Bi-directional cavopulmonary shunt associated with ventriculo and valvuloplasty in Ebstein’s anomaly: benefits in high risk patients. Eur J Cardiothorac Surg. 1998;13:514–9.

    Article  CAS  PubMed  Google Scholar 

  37. Al-Najashi KS, Balint OH, Oechslin E, Williams WG, Silversides CK. Mid-term outcomes in adults with Ebstein anomaly and cavopulmonary shunts. Ann Thorac Surg. 2009;88:131–6.

    Article  PubMed  Google Scholar 

  38. Babar JL, Jones RG, Hudsmith L, Steeds R, Guest P. Application of mr imaging in assessment and follow-up of congenital heart disease in adults. Radiographics. 2010;30(4):1145.

    Article  PubMed  Google Scholar 

  39. Kilner PJ, Geva T, Kaemmerer H, Trindade PT, Schwitter J, Webb GD. Recommendations for cardiovascular magnetic resonance in adults with congenital heart disease from the respective working groups of the european society of cardiology. Eur Heart J. 2010;31:794–805.

    Article  PubMed  Google Scholar 

  40. Chandrashekhar G, Sodhi KS, Saxena AK, Rohit MK, Khandelwal N. Correlation of 64 row mdct, echocardiography and cardiac catheterization angiography in assessment of pulmonary arterial anatomy in children with cyanotic congenital heart disease. Eur J Radiol. 2012;81:4211–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rachel M. Wald MD, FRCPC .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Tobler, D., Juan, L.J., Crean, A.M., Wald, R.M. (2014). Ebstein Anomaly. In: Saremi, F. (eds) Cardiac CT and MR for Adult Congenital Heart Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8875-0_15

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-8875-0_15

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-8874-3

  • Online ISBN: 978-1-4614-8875-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics