The Two Anomalies of Wilhelm Ebstein

From morphology of human body to reshaping a morphology of the society: heritage in the field of pathology of infectious diseases of Wilhelm Ebstein and work of councilman Sigismund Asch. A story how to counteract epidemics and to transform feudal system into civil democracy

Collected, primary resources enabled us to extract data that are scarcely present in medical literature of the two Breslauer morphologists of both the human body and - metaphorically - the society: Wilhelm Ebstein (1836-1912) and Sigismund Asch (1825-1901), particularly the latter, who described morphology of melanosis in his doctoral dissertation in 1846, to switch on reshaping social morphology of Wrocław (Breslau) in Virchow-like manner. In contrast to the main perspective of Ebstein's anomaly that has been finely described in past biographical papers, a primary aspect of infectious diseases is highlighted here in Ebstein's heritage. In 1869, his habilitation on recurrent typhus provided professional support for Asch. As Ebstein cared for the poor in shelters of Wrocław, Asch admitted poor patients from early morning hours to gain such a great esteem to be elected alderman. Asch's mentality corresponded to Ferdinand Lassalle's philosophy of the social democratic movement. In front of cholera epidemics, Asch contributed to medical control of meat, development of city canalization, establishment of green areas as well he deeply got involved in charity institutions for widows and orphans and was a model medical doctor to follow for much more famous Janusz Korczak who perished together with children from his orphanage in Nazi Concentration Camp in Treblinka. Asch was immortalized as "Doctor Klaus" in the popular play by Adolf L'Arronge and united people in progress from feudal discrimination to democracy and in fight for civil rights in industrial society to gradually replace aristocracy with meritocracy in the mainstream of development of modern society.

Neurological, Extracardiac, and Cardiac Manifestations of Ebstein's Anomaly Along With its Genetics, Diagnostic Techniques, Treatment Updates, and the Future Ahead

Ebstein's anomaly is a congenital heart defect characterized by the displacement of the tricuspid valve, and its leaflets to be malformed. Due to the defect involving the tricuspid valve, there is a reverse flow of blood into the right-sided atrium, which may lead to cardiac hypertrophy and edema of the lower extremities. There is a decreased flow of blood out of the right heart due to reduced right ventricular contractility and tricuspid regurgitation. Children afflicted with this anomaly usually suffer from atrial septal defect and this is usually diagnosed before birth on a routine ultrasound scan. In neonates, cyanosis can be seen due to right-to-left atrial shunting or as a result of severe congestive heart failure. If the infant has pulmonary hypertension, cyanosis is markedly increased as there will be a limitation in pulmonary blood flow. In adults, arrhythmias, cyanosis, and heart failure are seen. The bundle of Kent leads to the formation of an electrical conduction abnormality between the right ventricle and atrium. This leads to a condition commonly known as Wolff- Parkinson-White syndrome in patients. An enlarged spherical heart is usually present on a chest X-ray. ECG changes of Ebstein's anomaly show taller than usual P waves, PR prolongation, and right bundle branch block. There can be certain neurological and extracardiac manifestations too such as hemiplegia, stroke, dysarthria, etc. During fetal life, specifically at 16 and 20 weeks of gestation, the anomaly can be diagnosed via echocardiography. Prostaglandin infusion (PGE1) is given to maintain pulmonary circulation in neonates if cyanosis is seen. In children and adults with congestive cardiac failure due to this anomaly, medical management includes digoxin, beta-blockers, diuretics, and angiotensin converting enzyme (ACE) inhibitors to improve heart failure. Surgical treatment includes valve reconstruction. In this article, we review the pathophysiology, genetics, diagnosis, management, and prognosis of Ebstein's Anomaly along with a comprehensive discussion on its genetics, neurological manifestations, extracardiac features, and current advancements in treatment.

Ebstein's Anomaly: An Unanticipated Differential Diagnosis of Egg-on-Stick Appearance and the Diagnostic Dilemma

Patient: Female, 42-year-old

Final Diagnosis: Ebstein’s anomaly

Symptoms: Dyspnoea on exertion • early satiety • fatigue • orthopnea • PND • progressive abdominal swelling • weigh loss

Medication: —

Clinical Procedure: Paracentesis

Specialty: Cardiology

Adam Christian Thebesius' Channels into the Human Heart: the Thebesian Veins and the Thebesian Valve

In 1708, Adam Christian Thebesius, a 22-year-old student at Leiden University, presented his graduate thesis, Disputatio medica inauguralis de circulo sanguinis in corde. More than a doctoral dissertation, this groundbreaking work opened new channels into the study of the human coronary venous system. Thebesius' theory about the vascular communication between the coronary arteries and the chambers of the heart helped to advance understanding of hemodynamic principles and to clarify the physiologic pathways of the coronary circulation. The following article-the third in a trilogy about Lower Silesian scientists-provides an overview of the life story and achievements of this Silesian physician and innovator, whose name was immortalized in 2 cardiac eponyms: the Thebesian veins and the Thebesian valve.

Outcomes of Ebstein's Anomaly Patients Treated with Tricuspid Valvuloplasty or Tricuspid Valve Replacement: Experience of a Single Center

Background:

The incidence of Ebstein's anomaly is extremely low, and except for the Mayo Clinic, no cardiac center has reported on a sufficient number of patients. The aim of our study was to report the outcomes of Ebstein's anomaly patients treated with tricuspid valvuloplasty (TVP) or tricuspid valve replacement (TVR).

Methods:

TVP or TVR was performed in 245 patients from July 2006 to April 2016. We reviewed patients' records and contacted patients via outpatient service and over the telephone.

Results:

The mean follow-up time was 43.6 ± 32.6 months, and 224 (91.4%) patients underwent follow-up. The mean operative age was 31.2 ± 15.7 years. TVR was performed in 23 patients, and TVP was performed in 201 patients. The 30-day mortality rate was 1.3%, and the overall survival rate was 97.9% at 5 and 10 years. The early mortality rate of the TVP group was lower than that of the TVR group (0.5% vs. 8.7%, P = 0.028), and the overall mortality rate of the TVP group was lower than that of the TVR group, without statistical significance (1.0% vs. 8.7%). After propensity score matching, the rates of mortality and New York Heart Association class ≥ III were lower in the TVP group than those in the TVR group without statistical significance. Seven patients with Type B Wolff-Parkinson-White (WPW) syndrome underwent one-stage surgery, and arrhythmias disappeared. Six patients suffered from episodes of left ventricular outflow tract obstruction (LVOTO) during surgery. Severe LVOTO could be treated with reoperation of the atrialized right ventricle.

Conclusions:

Ebstein's anomaly patients treated with TVP or TVR can experience optimal outcomes with midterm follow-up. However, TVP should be the first-choice treatment. Optimal outcomes can be obtained from one-stage operation in patients with Type B WPW syndrome. Severe LVOTO during surgery might be related to improper operation of the atrialized right ventricle.