JUGULAR VENOUS PULSE IN EBSTEINS-ANOMALY - ECHOCARDIOGRAPHIC AND DOPPLER-ECHOCARDIOGRAPHIC STUDY

To clarify the characteristics of the jugular venous pulse and its gen esis in Ebstein's anomaly, 7 patients with Ebstein's anomaly and 10 no rmal subjects were studied using phonomechanocardiography and M-mode, two-dimensional, and Doppler echocardiography. A right atrial pressure study was also performed in 4 of the 7 patients. There were 5 patient s with predominant tricuspid regurgitation and 2 with a mild anomaly. A large 'c' wave was observed in the jugular venous pulse in 5 patient s and in the right atrial pressure curve in 4. The upstroke of the jug ular 'c' wave preceded that of the carotid arterial pulse by 35.0 ms. The interval from QRS complex onset to tricuspid valve closure was sig nificantly longer and the dosing excursion of the anterior tricuspid l eaflet significantly larger in the patients than in the normal subject s. There was a trend for a positive correlation between QRS onset to j ugular 'c' wave peak interval and QRS onset to tricuspid valve closure interval. The jugular 'c' wave height exhibited significant positive correlations with the size of the atrialized right ventricle and the m itral to tricuspid anulus distance, but it showed no obvious correlati on with the grade of tricuspid regurgitation. These results suggest th at augmentation of the jugular 'c' wave is characteristic of Ebstein's anomaly and that it correlates closely with the severity of displacem ent of the tricuspid valve.