Ebstein's anomaly of tricuspid valve: critical review of roentgenological features and additional angiographic signs

The plain roentgenographic and angiocardiographic features of 15 patients with Ebstein's anomaly of the tricuspid valve were reviewed. Of note on the plain roentgenogram was the fact that the 'posterior bulge' seen on the lateral view was demonstrated to be due to either a markedly enlarged right atrium or the posterior displacement of normal left heart structures. The angiocardiographic features described in the literature were reviewed. Two main features seen were the 'sail like' appearance of the anterior leaflet of the tricuspid valve, which sometimes produces a tumor like picture, and the 2 notches seen when the ventricle contracts. One notch corresponds to the true tricuspid annulus. The other represents the site of attachment of the displaced tricuspid valve. The previously undescribed features were noted: all three leaflets could sometimes be identified; fenestrations in the anterior leaflet were demonstrated in 5 cases; and the sinus portion of the ventricle was sometimes filled in a retrograde fashion from the infundibular chamber.