Demonstration of Ebstein's anomaly by simultaneous catheter-tip localization of the tricuspid valve visualization: A new method.

The diagnosis of Ebstein's anomaly has traditionally been made by angiocardiography and confirmed by simultaneous intracardiac electrocardiographic and pressure recordings. These techniques may result in false positive or negative tests. A new method is proposed, whereby the right coronary artery is used an an angiographic marker for the tricuspid annulus and a pressure catheter simultaneously marks the position of the tricuspid valve. In the right anterior oblique position the tip of the pressure catheter should be just under the right coronary artery as the tricuspid leaflets close in systole, indicating the normal relationship of the tricuspid leaflets and annulus. In Ebstein's anomaly the tip of the catheter extends well past the coronary artery in systole, demonstrating the characteristic displacement of the attachments of the tricuspid valve downward toward the right ventricular apex.