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Logo of thijTexas Heart Institute JournalSee also Cardiovascular Diseases Journal in PMCSubscribeSubmissionsTHI Journal Website
Tex Heart Inst J. 2009; 36(5): 496–497.
PMCID: PMC2763458

Bioprosthetic Tricuspid Valve Dehiscence in a Patient with Ebstein Anomaly

Raymond F. Stainback, MD, Section Editor
Department of Adult Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, 6624 Fannin Street, Suite 2480, Houston, TX 77030

A 26-year-old man was referred to our echocardiography department for further evaluation of lower-extremity edema and significant ascites. At the age of 10 years, he had experienced severe tricuspid valve regurgitation associated with Ebstein anomaly; his tricuspid valve was replaced with a bioprosthetic valve. After the operation, the patient had been lost to follow-up; he returned for examination when he became symptomatic. The patient had a history of dyspnea, which had worsened during the 3 to 4 months before the current visit. He also reported that the ascites and edema had worsened during the last year. At the current admission, transthoracic echocardiography (TTE) showed a severely enlarged right ventricle and greatly reduced right ventricular function (Fig. 1); TTE also revealed dehiscence of the bioprosthetic valve (Fig. 2). Transesophageal echocardiography confirmed severe valvular leakage and almost no flow from the bioprosthetic valve (Fig. 3); in addition, the valve had detached from the medial side of the leaflet. Because of the severely enlarged right ventricle and greatly reduced right ventricular function, the only option for treating this patient was heart transplantation. He underwent successful heart transplantation and had an uneventful postoperative course.

figure 33FF1
Fig. 1 Transthoracic echocardiogram in short-axis view shows the left ventricle and the severely enlarged right ventricle.
figure 33FF2
Fig. 2 Transthoracic echocardiogram in 4-chamber view shows the severely enlarged right ventricle and dehiscence of the bioprosthetic tricuspid valve.
figure 33FF3
Fig. 3 Transesophageal echocardiogram in 4-chamber view confirms dehiscence of the bioprosthetic tricuspid valve.


The common feature in all cases of Ebstein anomaly is the apical displacement of the septal tricuspid valve leaflet. In our patient, apical displacement of the tricuspid valve leaflets was not seen during the current admission, because of surgical resection of the native tricuspid valve and annular placement of the bioprosthesis; in addition, the right ventricle was severely enlarged.

Supplementary Material

Video for Fig. 1:
Video for Fig. 2:


Address for reprints: Maryam Moshkani Farahani, MD, Department of Echocardiography, Baqiatallah University of Medical Sciences, 477, Block 18, Shahrak-e-pass, Sheikh Fazlollah Noori Highway, Tehran 1464894793, Iran E-mail: moc.oohay@inaharaf;f5000x#&inakhsom

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute