Ebstein Anomaly

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WHO-ICD-10 version:2010

Congenital malformations, deformations and chromosomal abnormalities

Congenital malformations of the circulatory system

OMIM Number

224700

Mode of Inheritance

Autosomal recessive

Description

Ebstein anomaly is a rare congenital malformation of the heart that occurs in approximately 1 per 200,000 live births, which accounts for about 0.5% of all cases of congenital heart disease. In this condition, the tricuspid valve is located lower than normal, so the upper part of the right ventricle becomes incorporated into the right atrium making the right ventricle too small and the right atrium too large. Besides that, leaflets that make up the tricuspid valve opening are malformed allowing blood to leak back into the atrium after it has flowed into the ventricle. This backward flow of blood also contributes to the size anomaly of the atrium and the ventricle. The cardinal symptoms in Ebstein's anomaly are cyanosis, right-sided heart failure, arrhythmias, and sudden cardiac death. Newborns with this condition usually appear blue at birth, have difficulties in breathing, feeding, and may require immediate surgical treatment in infancy. Most adults with this condition only have mild symptoms and may have a normal life expectancy. Ebstein's anomaly is commonly associated with other heart problems including atrial septal defect, arrhythmias, pulmonary stenosis, and arrhythmias.

The causes of this condition are still uncertain, but genetic and environmental factors are both thought to play a role. For example, it is found that women who ingest lithium during the first trimester of pregnancy are at higher risk for having children with this condition. Also, risk is higher in whites than in other races.

Molecular Genetics

There are heterogeneous genetic factors in Ebstein's anomaly. Most cases of Ebstein's anomaly are sporadic, whereas familial Ebstein's anomaly is rare.

Epidemiology in the Arab World

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Other Reports

Bahrain

Krishnamurthy et al. (1989) reported a case of Ebstein's anomaly causing left recurrent laryngeal nerve paralysis in a neonate. This is the first reported case of vocal cord paralysis associated with this condition.

Qatar

In a study by El-Menyar et al. (2006) analyzing data pertaining to all patients less than 50-years of age, who were hospitalized between 1996 and 2003 with cardiomyopathy in Qatar, a rare association was noticed in one patient with comorbidity of left ventricular noncompaction cardiomyopathy and Ebstein disease.  The patient was a 1-year old female with a normal ejection fraction.

Sudan

Ali and Nimeri (2006) conducted a retrospective analysis for 12 patients with Ebstein anomaly and diagnosed from July 2004 to April 2005. Ebstein anomaly patients constituted 2% of all patients seen with congenital cardiac disease for the same period. The age ranged from 2 weeks to 35 years. Of the patients, half were asymptomatic, while the other half presented with congestive cardiac failure, four of these having cyanosis in addition to heart failure. Associated diseases included chronic renal failure, impaired hearing, stunted growth, and developmental delay. Electrocardiographic abnormalities included peaked and tall P waves, seen in four-fifths, an Rsr pattern, first degree atrioventricular block, atrial fibrillation, and Wolf-Parkinson-White syndrome, including the Mahaim pattern of pre-excitation. Associated abnormalities diagnosed echocardiographically included atrial septal defects, prolapse of the leaflets of the mitral valve, left ventricular dysfunction, atrial septal aneurysm, pulmonary valvar stenosis, and pericardial effusion.

Sulafa and Karani (2007) further confirmed the frequent occurrence of Ebstein anomaly in Sudan in a retrospective analysis that included 435 patients with abnormal hearts and seen at Sudan Heart Centre from July 2004 to June 2005. Congenital heart disease constituted 87% and acquired heart disease and rhythm disorders 13%. However, Ebstein anomaly was noted to be four times more frequent than reported worldwide.

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