Gussenhoven E J, Stewart P A, Becker A E, Essed C E, Ligtvoet K M, De Villeneuve V H
Am J Cardiol. 1984 Jul 1;54(1):172-6. doi: 10.1016/0002-9149(84)90324-2.
Apical displacement of the septal tricuspid valve leaflet is considered the most reliable criterion to diagnose Ebstein's anomaly. This feature is best assessed using 2-dimensional echocardiography. However, the anatomy in Ebstein's anomaly is highly variable; therefore, the problem arises as to how to distinguish between the abnormal displacement in borderline cases of Ebstein's disease and the lowered septal offsetting of the tricuspid valve in normal persons. To solve this problem the minimal and maximal differences in offsetting of the tricuspid and mitral valves have been studied, both anatomically and echocardiographically, in fetuses, infants, children and adults. In fetuses in the first trimester of pregnancy it was impossible to measure a difference in offsetting of the 2 atrioventricular valves. Thereafter, a gradual increase occurred with age. In normal hearts the most significant separation was usually recorded in anteriorly angulated 4-chamber views, whereas in hearts with Ebstein's anomaly maximal separation appeared to posteriorly angulated views. The anatomic and echographic measurements showed a constant relation. When the minimal distances in offsetting were measured, an overlap was found between cases with and those without Ebstein's anomaly. The maximal values, however, clearly discriminated between the 2 conditions. The critical difference in children was 15 mm, and in adults the discriminating value was 20 mm.
房间隔三尖瓣叶的顶端移位被认为是诊断埃布斯坦畸形最可靠的标准。使用二维超声心动图可以最好地评估这一特征。然而，埃布斯坦畸形的解剖结构高度可变；因此，出现了一个问题，即如何区分埃布斯坦病临界病例中的异常移位与正常人三尖瓣隔叶偏移降低的情况。为了解决这个问题，已经从解剖学和超声心动图方面研究了胎儿、婴儿、儿童和成人三尖瓣和二尖瓣偏移的最小和最大差异。在妊娠早期的胎儿中，无法测量两个房室瓣偏移的差异。此后，随着年龄的增长逐渐增加。在正常心脏中，最显著的分离通常记录在向前成角的四腔视图中，而在患有埃布斯坦畸形的心脏中，最大分离似乎出现在向后成角的视图中。解剖学和超声测量显示出恒定的关系。当测量偏移的最小距离时，发现有和没有埃布斯坦畸形的病例之间存在重叠。然而，最大值清楚地区分了这两种情况。儿童的临界差异为15毫米，成人的鉴别值为20毫米。
