Jugular Venous Pulse in Ebstein's Anomaly: Echocardiographie and Doppler Echocardiographie Study

Abstract

To clarify the characteristics of the jugular venous pulse and its genesis in Ebstein's anomaly, 7 patients with Ebstein’s anomaly and 10 normal 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 patients with predominant tricuspid regurgitation and 2 with a mild anomaly. A large 'c' wave was observed in the jugular venous pulse in 5 patients and in the right atrial pressure curve in 4. The upstroke of the jugular 'c' wave preceded that of the carotid arterial pulse by 35.0 ms. The interval from QRS complex onset to tricuspid valve closure was significantly longer and the closing excursion of the anterior tricuspid leaflet significantly larger in the patients than in the normal subjects. There was a trend for a positive correlation between QRS onset to jugular '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 mitral to tricuspid anulus distance, but it showed no obvious correlation with the grade of tricuspid regurgitation. These results suggest that augmentation of the jugular 'c' wave is characteristic of Ebstein's anomaly and that it correlates closely with the severity of displacement of the tricuspid valve.