The annulus of the valve is still in the normal position. The valve leaflets, however, are to a varying degree, attached to the walls and septum of the right ventricle. A subsequent "atrialization" of a portion of the morphologic right ventricle (which is then contiguous with the right atrium) is seen. This causes the right atrium to be large and the anatomic right ventricle to be small in size. * S3 heart sound * S4 heart sound * Triple or quadruple gallop due to widely split S1 and S2 sounds plus a loud S3 and/or S4 * Systolic murmur of tricuspid regurgitation = Holosystolic or early systolic murmur along the lower left sternal border depending on the severity of the regurgitation * Right atrial hypertrophy * Right ventricular conduction defects * Wolff-Parkinson-White syndrome often accompanies Related abnormalities fibrous ring down into the right ventricle. While<unk>  is defined as the congenital displacement of the tricuspid valve towards the apex of the right ventricle, it is often associated with other abnormalities. Anatomic abnormalities Typically, anatomic abnormalities of the tricuspid valve exist, with enlargement of the anterior leaflet of the valve. The other leaflets are described as being plastered to the endocardium. Tethering the underlying ventricular wall is the most common for the posterior and septal leaflets, and sail-like anterior leaflets may be tethered to the RV free wall also. ECGs recorded during sinus rhythm and AVRT in a 9-year-old girl with<unk>  and a Mahaim accessory pathway. About 50% of individuals with<unk>  have an associated shunt between the right and left atria, either an atrial septal defect or a patent foramen ovale. Electrophysiologic abnormalities About 50% of individuals with<unk>  have an accessory pathway with evidence of Wolff-Parkinson-White syndrome, secondary to the atrialized right ventricular tissue. This can lead to abnormal heart rhythms including atrioventricular re-entrant tachycardia. A 10-lead ECG of a woman with<unk> : The ECG shows signs of right atrial enlargement, best seen in V1. Other P waves are broad and tall, these are termed "Himalayan" P waves. Also, a right bundle-branch block pattern and a first-degree atrioventricular block (prolonged PR-interval) due to intra-atrial conduction delay are seen. No evidence of a Kent-bundle is seen in this patient. The T wave inversion in V1-4 and a marked Q wave in III occur; these changes are characteristic for<unk>  and do not reflect ischemic ECG changes in this patient. Other abnormalities that can be seen on the ECG include: # signs of right atrial enlargement or tall and broad 'Himalayan' P waves # first degree atrioventricular block manifesting as a prolonged PR-interval # low amplitude QRS complexes in the right precordial leads # atypical right bundle branch block # T wave inversion in V1-V4 and Q waves in V1-V4 and II, III and aVF.
Ebstein's anomaly
Tetralogy of Fallot  Tetralogy of Fallot  1
Jordans' anomaly
First arch syndrome
Choanal atresia
Double aortic arch
Pulmonary atresia
May–Hegglin anomaly