Ebstein anomaly of the tricuspid valve consists of-

Ans. is 'c' i.e., Downward displacement of an abnormal tricuspid valve into the right ventricleEbstein's anomalyo Ebstein anomaly consists of downward displacement of an abnormal tricuspid valve into the right ventricle,o Normally tricuspid valve has three leaflets - Anterior, posterior and septal,o Fixed end of these leaflets is attached to valve ring in tricuspid area.o In Ebstein anomaly, anterior leaflet is attached to valve ring as normal, but the other two leaflets (posterior and septal) are displaced downward and are attached to the wall of left ventricle,o The portion of right ventricle above he tricuspid valve becomes a part of right atrium - atrialized right ventricle.Hemodynamicso The tricuspid valve anomaly results in obstruction of blood flow as well as regurgitation of blood from the right ventricle into the right atrium - Dilatation and hypertrophy of right atrium due to volume overload,o Blood flows right atrium to left atrium through patent foramen ovale or ASD - Right to left shunt and cyanosis.Clinical manifestationso Cyanosiso Fatigueo Dysnea on exertiono Paroxysmal attacks of tachycardiaSignso Cyanosis and clubbingo S2 wides split but variableo Dominant V wave on AVP.o Right ventricular S3o Systolic thrill at the left sternal bordero Right atrial S4.o S1 normalo Systolic murmur due to regurgitation at tricuspid valve.o Delayed diastolic murmur due to obustruction at tricuspid valve like tricuspid stenosis.o Both systolic and diastolic murmur produced at the tricuspid valve have scratchy character like pericardial friction rib.