Thrombosed Prosthetic Tricuspid Valve in Ebsteins Anomaly

cardiac CT of ebstein\'s anomaly
A 68-year-old woman with known Ebstein’s anomaly (EA) was admitted for the investigation of progressive breathlessness, reduced exercise tolerance (NYHA grade 2) and increasing leg swelling. On the current admission, a 64-slice coronary CT was undertaken to exclude hemodynamicaly significant coronary disease. Thrombus was identified lodged between the medial valve flap and the valve ring. Multiphasic cine CT throughout the cardiac cycle demonstrated immobility of the tricuspid valve leaflets.

Ebstein’s anomaly is a rare congenital cardiac malformation characterized by apical displacement of the septal and posterior tricuspid leaflets, resulting in atrialization of the right ventricle. Medical management includes treatment for heart failure and complex cardiac arrhythmias. Surgical tricuspid valve repair is undertaken in severe cases of tricuspid regurgitation.

Recent technical advances in cardiac CT, using retrospective ECG-gated image reconstruction, have allowed evaluation of both native and prosthetic cardiac valves. In the current case, echocardiography was unable to clearly depict the precise etiology for the malfunctioning valve, which was subsequently diagnosed as thrombus-related using cardiac CT.

Credit: Dr Simon Walsh