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‘A ring in the heart’
  1. Thomas C Butler1,
  2. Douglas Wall2,
  3. Christian Hamilton-Craig1
  1. 1 Cardiology Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
  2. 2 Department of Cardiac Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
  1. Correspondence to Dr Thomas C Butler, Cardiology Department, The Prince Charles Hospital, 30 Liverpool Road, Clayfield, Brisbane, QLD 4011, Australia; tombutler30{at}

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Clinical introduction

A 39-year-old man was referred with a history of progressive shortness of breath, NYHA class II, for further evaluation. Clinical examination revealed prominent V-waves in the jugular venous pulse, a parasternal heave and a soft systolic murmur at the left sternal edge. Respiratory function tests were normal and d-dimer was negative. Echocardiography demonstrated severe RV dilation, severe tricuspid regurgitation and an apically displaced septal leaflet of the tricuspid valve typical of Ebstein's anomaly (see online supplementary appendix movie 1). An abnormality was noted attached to the atrial aspect of the tricuspid valve on transthoracic and transoesophageal imaging (Figure 1A, B as well as online …

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  • Contributors All authors have made a substantial contribution to this submission. TCB: case write up and preparation of imaging; CH-C: TOE imaging (Cardiologist and Editing of Case); DW, Surgeon involved with case.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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