Role of Comprehensive Perioperative Transesophageal Echocardiography in Ebstein\'s Anomaly

Ebstein's anomaly (EA) is a complex congenital anomaly with a broad morphological spectrum.Although typically characterized by apical displacement of the septal tricuspid leaflet (STL) ≥8 mm/m 2 body surface area (BSA), diagnostic categorization is confusing in cases with minor downward displacement of the leaflets.A comprehensive transesophageal echocardiography (TEE) has an integral role in the surgical decision-making and perioperative management of EA.Preoperative TEE aims to provide the morphological diagnosis, coexistent cardiac lesions most commonly, atrial septal defect (ASD), degree of atrialization of the right ventricle (RV), size of the functional RV, biventricular function, quantification of the resultant tricuspid regurgitation (TR), and the amenability of the leaflets to surgical repair.Postoperatively, TEE examination can elucidate valuable information about the competency of tricuspid apparatus, RV dysfunction, and any residual shunting across ASD.Threedimensional echocardiography has been especially employed to study the leaflet morphology and coaptation defects.The TEE is also indispensable in guiding the management of critically sick neonates with EA.The Great Ormond Street Echocardiography (GOSE) score predicts mortality in neonatal EA and has been proposed for risk stratification.The TEE is also helpful in identifying the cases which are not suitable for a biventricular repair and the ones which may require a valve replacement.