Paradoxical splitting of the second heart sound in the Wolff-Parkinson-White syndrome

Reversed splitting of the second heart sound due to tricuspid regurgitation

A previously unreported cause of reversed splitting of the second heart sound is described. This patient had tricuspid regurgitation which caused early closure of the pulmonary valve leading to reversed splitting. Left ventricular function and aortic valve closure were normal.

Evaluation of heart sounds and murmurs in children

Auscultation is the core of pediatric cardiovascular evaluation and should be performed according to a routine. The four heart sounds should be sought in order at their usual locations, with particular attention to the second sound because of its important diagnostic role in congenital cyanotic heart disease. The next sounds to listen for are clicks, which can be systolic, pulmonary, aortic, or midsystolic. Finally, murmurs should be sought in systole and then diastole. Besides being identified as systolic, diastolic, or continuous, murmurs should be characterized according to their relationship with the first and second heart sounds, intensity, frequency, and maximum location and radiation.

Left ventricular posterior wall motion in patients with the Wolff-Parkinson-White syndrome

Echocardiography appears to be a sensitive technique for detecting disturbances in left ventricular posterior wall motion in subjects with WPW type A. The characteristic abnormality consists of premature anterior displacement of the LVPW shortly after the inscription of the delta wave. The ability to detect abnormal wall motion is influenced by the size of the segment of myocardium undergoing pre-excitation, the site of insertion of the anomalous pathway, and its accessibility to echocardiographic study. The results of this study support the concept that WPW type A represents premature excitation of the posterior left ventricular wall in some patients. Moreover, such pre-excitation may be associated with an altered pattern of left ventricular contraction. A similar pattern of LVPW motion was not observed in a large group of randomly selected clinical echocardiograms including a variety of intraventricular conduction disturbances.

Echocardiogram in Ebstein's anomaly with Wolff-Parkinson-White preexcitation syndrome, type B

The echocardiographic features of Ebstein's anomaly include a large anterior chamber, paradoxic ventricular septal motion (type B), increased velocity and amplitude of anterior tricuspid leaflet (ATL) motion, and delayed closure of the ATL. This delayed closure has been thought to be secondary to right bundle-branch block (RBBB). We have studied two patients by simultaneous echocardiography and phonocardiography. The findings in both patients were similar. One patient had RBBB and therefore resembles the previously reported patients. However, the other patient had W-P-W preexcitation syndrome, type B, and is reported here in more detail. The ATL closure of this patient was markedly delayed in spite of right ventricular preexcitation. This finding gives further insight into the altered pathophysiology in Ebstein's anomaly and implies that the delayed ATL closure is probably not due to RBBB and may be a specific feature of this anomaly.