Ebstein's anomaly

Here, a patient with Ebstein's anomaly. This anomaly has been associated with maternal lithium use during pregnancy, although most cases are sporadic. It is characterized by various degree of displacement of the tricuspid valve towards the apex of the RV, with the posterior and septal leaflets being displaced.  This leads to "atrialization" of the RV segment included in the right atrium, with subsequent enlargement of the RA and decreased RV functional cavity. 

Ebstein's anomaly is associated with atrial septal defect, Wolff-Parkinson-White (and supra-ventricular tachycardia) and risk of strokes. Often, these patients present with an enlarged cardiac silhouette on chest radiography (“Wall to Wall" heart).

Severe Ebstein's can be associated with the "Circular shunt physiology" (or "Circle of death"), a flow physiology by which blood flow goes from Right to Left atrium (via the ASD/inter-atrial shunt), to the Left ventricle, to the Aorta, to the Pulmonary artery (by the PDA) to the right ventricle (by pulmonary insufficiency), to the right atrium (via the tricuspid regurgitation), to the left atrium by the ASD.

More on Ebstein's anomaly by clicking here (outside article).

More on fetal Ebstein and circular shunt physiology here.