Hemodynamic discordance and rarity claims in a congenital ebsteinoid triad: a call for clarification

Mohammad Omar Tunio; Muhammad Aslam; Yashwini Sawlani; Salman Irshad Abbasi; Muhammad Amir Gadhi

doi:10.1186/s43044-026-00801-z

November 11, 2026The Egyptian Heart JournalOpen Access

Hemodynamic discordance and rarity claims in a congenital ebsteinoid triad: a call for clarification

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Key Points

To clarify the physiological interpretation of discordant Doppler and invasive pressure measurements and evaluate the basis for rarity claims in a reported congenital ebsteinoid triad.
Critical correspondence analyzing a published case report of a 15-year-old adolescent with an Ebsteinoid tricuspid valve anomaly, giant right atrial aneurysm, and secundum atrial septal defect.
Re-evaluation of reported Doppler echocardiography, right-heart catheterization hemodynamics, and relevant published anatomical comparators.
The reported continuous-wave Doppler peak tricuspid regurgitation velocity of 3.39 m/s yielded a trans-tricuspid gradient of 46 mmHg, which exceeded the invasively measured right ventricular pressure of 32/6 mmHg, mean right atrial pressure of 8 mmHg, and pulmonary artery pressure of 28/12 mmHg (mean 18 mmHg).
Contradictory jet trajectory descriptions—eccentric-posterior versus directed toward the interatrial septum—require clarification regarding imaging planes and Doppler alignment before invoking wall-hugging Coanda effects or altered atrial compliance.
Related congenital variants exist in the literature, supporting qualified descriptions such as 'rarely reported' or 'an unusual combination' over unqualified claims of exceptional rarity.

Structured PICO

P

Population

One 15-year-old adolescent patient with an Ebsteinoid tricuspid valve anomaly, a giant right atrial aneurysm, and a secundum atrial septal defect (ASD) discussed in a previously published case report

I

Intervention

Multimodality imaging (echocardiography, cardiac CT), right-heart catheterisation, and surgical repair including right atrial reduction atrioplasty with preservation of conduction tissue

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Implication

This correspondence emphasizes the need for careful hemodynamic interpretation when reconciling discordant echocardiographic Doppler tricuspid regurgitation gradients and invasive right-heart catheterization pressures in complex congenital heart disease.

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Cite This Study

Tunio et al. (2026) studied this question.

synapsesocial.com/papers/6af5ce2ea40bbe8669e89cf9 https://doi.org/10.1186/s43044-026-00801-z

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Hemodynamic discordance and rarity claims in a congenital ebsteinoid triad: a call for clarification

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Hemodynamic discordance and rarity claims in a congenital ebsteinoid triad: a call for clarification

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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