Figure 3 : Cardiac imaging of a pregnant woman with ebstein anomaly.

A 36 year old woman, without prior pregnancies, originally from Equador, presented for evaluation of a cardiac murmur and palpitations in pregnancy. She complained of NYHA Class II symptoms at prior to pregnancy, worsening to class III during pregnancy. She had no clinical evidence of cyanosis and no pre-excitation on electrocardiography.
Panel A: Apical four chamber view demonstrates severe right atrial (RA) enlargement and severe right ventricular (RV) enlargement, the atrialized right ventricle (ARV), and the apically displaced tricuspid valve (white arrow) consistent with Ebstein anomaly.
Panel B: Demonstrates severe tricuspid regurgitation (TR).
Panel C: Demonstrates a triangular contour of the spectral Doppler of the tricuspid regurgitation, consistent with severe tricuspid regurgitation. The right ventricular systolic pressure, as estimated using the tricuspid regurgitation velocity of 2.27 m/s and with an assumed right atrial pressure of 15 mmHg, was normal at 35.6 mmHg.
Color Doppler seen along the interatrial septum was consistent with the presence of a patent foramen ovale or small atrial septal defect(not shown). Fetal cardiac ultrasound performed at 22 weeks was normal (not shown). She was noted to have fetal growth restriction at 37 weeks and was admitted for induction of labor; she was delivered vaginally with an assisted second stage of labor and an epidural without clinical event.
Panel D: Cardiac magnetic resonance imaging (SSFP sequence) performed postpartum demonstrates severely enlarged right ventricular size and severely reduced right ventricular systolic function with a right ventricular ejection fraction of 27 %, as well as findings consistent with Ebstein anomaly and severe tricuspid regurgitation. At this time, she was admitted 8 days postpartum for heart failure symptoms. After medical stabilization, she underwent an uncomplicated tricuspid valve replacement with a bioprosthesis.

Stergiopoulos et al.Cardiovascular System  2015 3:7DOI : 10.7243/2052-4358-3-7