Ebstein’s malformation of the tricuspid valve
by Franklin B Saksena, Ranganathan Narasimhan, Sivaciyan Vahe

The Art and Science of Cardiac Physical Examination (With Heart Sounds, Jugular and Precordial Pulsations)

by Narasimhan Ranganathan, Vahe Sivaciyan, Franklin B Saksena
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This recording is from a patient taken from the apex area. One can recognize a loud S1, which appears to be single. When the patient is instructed to breathe, one can hear an inspiratory noise in the background, which distorts the phono. Following this one can note that the S1 intensity becomes louder, confirming a loud T1 component in this patient. This recording was from a 20 year old woman who had an Ebstein’s malformation of the tricuspid valve. In this congenital anomaly, the tricuspid valve is deformed and displaced downwards towards the right ventricle with partial atrialization of the right ventricle. There could be asynchronous closure of the tricuspid valve, which can lead to a loud delayed T1 component.

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