The heart sounds and murmurs are described in IO patients with Ebstein's anomaly, in 6 of whom the diagnosis had been confirmed by catheterization and angiocardiography or by necropsy. While wide splitting of the second sound, diastolic sounds, pansystolic murmurs, and diastolic murmurs were found in most, the only constant abnormality was abnormally wide splitting of the first sound with accentuation of the delayed component. This abnormal sound was thought to be caused by delayed closure of the abnormally large anterior leaflet of the tricuspid valve, especially as its delay was almost exactly related to the degree of right bundle-branch block. Ultrasonic recordingsfrom the tricuspid valve and mitral valve with simultaneous phonocardiograms were successfully obtained in 3 cases. While mitral closure occurred at the normal time, tricuspid closure was greatly delayed and coincided exactly with the abnormal sound. It is concluded that tricuspid closure tends to be abnormally loud and late in Ebstein's anomaly serving as a useful sign in diagnosis. Furthermore, the intensity of the sound despite a hypodynamic right ventricle is of interest in relation to the mechanism of heart sounds. tained by repeating the impulses Ioo times a
In a 60-year-old male with WPW syndrome and recurrent PAT refractory to cardiac drugs, surgical creation of complete A-V block without cardiopulmonary bypass has prevented recurrence of the PAT. The findings in this case support the accessory conduction tissue theory as being responsible for WPW conduction in some patients and a circus re-entry movement as responsible for the recurring PAT.
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