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In Ebstein’s anomaly, there is downward or apical displacement of posterior and septal tricuspid leaflets. The anterior leaflet is not displaced, but is elongated to meet the other leaflets, so that when it closes, a loud sound, tricuspid sound, is produced, which is called as the sail sound.
And that will be the approximate level of the tricuspid valve, the reference point for measuring right atrial pressure. In right atrial tracing, this occurs at the time of right ventricular contraction, with bulging upwards of the tricuspid valve. The Y descent is shallow in tricuspid stenosis, and absent in cardiac tamponade.
Tricuspid regurgitation jet velocity and pulmonary regurgitation end diastolic velocity indicating pulmonary hypertension are also taken as surrogates of left atrial pressure in the absence of pulmonary disease. Doppler interrogation of mitral valve is usually done from the apex through the apical four chamber view.
Bernoulli equation (P=4V 2 ) gives the gradient of tricuspid regurgitation flow, which corresponds to the pressure difference between right ventricle and right atrium in systole.
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