Shiina et al developed a simple echocardiographic index for evaluating patients with Ebstein's anomaly of the tricuspid valve. This can help to determine the optimum therapy for a patient. The authors are from the Mayo Clinic in Rochester.
Parameters:
(1) tethering and restricted motion of the anterior leaflet
(2) functional right ventricle
(3) septal leaflet
(4) placement of anterior leaflet
(5) right ventricular outflow
(6) diameter of right atrium adjusted for BSA
(7) trisucpid prolapse
|
Parameter |
Finding |
Points |
|
tethering and motion anterior leaflet |
severe tethering |
3 |
|
|
restricted motion |
2 |
|
|
mild tethering |
1 |
|
|
untethered and unrestricted |
0 |
|
functional right ventricle |
>= 35% |
0 |
|
|
< 35% |
2 |
|
septal leaflet |
present |
0 |
|
|
absent |
1 |
|
anterior leaflet |
not displaced |
0 |
|
|
displaced |
1 |
|
right ventricular outflow |
not aneurysmal |
0 |
|
|
aneurysmal |
1 |
|
right atrial diameter |
<= 60 mm per square meter BSA |
0 |
|
|
> 60 mm per square meter BSA |
1 |
|
tricuspid prolapse |
none |
0 |
|
|
mild or moderate |
0 |
|
|
severe |
1 |
where:
• The scoring of the index is a bit ambiguous. Restricted motion of the anterior leaflet is either independent measure or related to tethering of the anterior leaflet. I assumed the latter since Figure 7 shows the maximum score to be 10. If restricted motion was independent then the maximum score would be 12.
index =
= SUM(points for all 7 parameters)
Interpretation:
• minimum index: 0
• maximum index: 10 (according to Figure 7, see comment above)
• The higher the index the greater the need for surgery.
Management options:
(1) medical
(2) plastic surgical repair
(3) valve replacement
|
Index |
NYHA Functional Class |
Suggested Management |
|
<= 2 |
I or II |
medical |
|
0 - 4 |
III or IV |
plastic repair |
|
>= 5 |
NA |
valve replacement |
where:
• The New York Heart Association (NYHA) functional classification is described in 37.06.09. Class I is normal and Class IV is bedridden.
Specialty: Cardiology
ICD-10: ,
