THE SAIL SOUND AND TRICUSPID REGURGITATION IN EBSTEINS-ANOMALY - THE VALUE OF ECHOCARDIOGRAPHY IN EVALUATING THEIR MECHANISMS

We describe a patient with Ebstein's anomaly in whom Doppler echocardi ography was used to clarify the mechanism responsible for 'sail sound' and tricuspid regurgitation associated with this condition. Phonocard iography revealed an additional early systolic heart sound, consisting of a first low-amplitude component (T-1) and a second high-amplitude component (T-2, 'sail sound'). In simultaneous recordings of the tricu spid valve motion using M mode echocardiography and phonocardiography, the closing of the tricuspid valve occurred with T-1 which originated at the tip of the tricuspid leaflets, while T-2 originated from the b ody of the tricuspid leaflets. Using color Doppler imaging, the tricus pid regurgitant signal was detected during pansystole, indicating a bl ue signal during the phase corresponding to T-1 and a mosaic signal du ring the phase corresponding to T-2 at end-systole. Thus, 'sail sound' in patients with Ebstein's anomaly is not simply a closing sound of t he tricuspid valve, but a complex closing sound which includes a sudde n stopping sound after the anterior and/or other tricuspid leaflets ba lloon out at systole.