A perfect storm: Wolf Parkinson White syndrome, Ebstein's anomaly, biventricular non-compaction, and bicuspid aortic valve.

Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE Consensus Statement on Methodology and Indications. Endorsed by the Japanese Society of Echocardiography. European association of echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. et al. Test-retest reliability of assessment for intraventricular dyssynchrony by tissue Doppler imaging echocardiography. toxicity screening by echocardiography in healthy volunteers: a study of the effects of diurnal variation and use of a core laboratory on the reproducibility of left ventricular function measurement. et al. Left ventricular long-axis changes in early diastole and systole. Cantales DR et al. Assessment of left atrial appendage function with transthoracic tissue Doppler echo-cardiography. Evaluation of tissue Doppler-based velocity and deformation imaging: a phantom study of ultrasound systems. velocity-time-integral ratio and peak velocity ratio for calculation of the dimension-less index (or aortic valve area) in serial follow-up of aortic stenosis. A 14-year-old African boy presented for routine clinical assessment to evaluate a systolic murmur. The surface electrocardiogram showed sinus rhythm and the left postero-septal accessory pathway of Wolf Parkinson White syndrome (Panel A). Transthoracic echocardiography demonstrated features of Ebstein's anomaly (Panel B and see Supplementary data online, Video S1): the downward (apical) displacement of septal leaflets of the tricuspid valve was 45 mm (28.8 mm/m 2) with mild regurgitation at colour flow Doppler, leading to atrialization of the right ventricle (RV). There was extensive thickening and trabeculation of the apical half of the left ven-tricle (LV). Colour Doppler displayed a flow within the deep intertrabecular recesses. The LV was dilated with moderately depressed global systolic function. The RV appeared to be more heavily trabeculated than usual, but there was no dilatation. It had normal systolic function and the pulmonary artery systolic pressure was only 18 mmHg. The findings were suspected for non-compaction of the ventricular myocardium (Panel C): patient's family refused magnetic resonance imaging making this diagnosis just alleged. Finally, we reported a congenital bicuspid aortic valve with mild-to-moderate eccentric regurgitation (Panel D and see Supplementary data online, Video S2) and normal dimension of the aortic root. Medline search revealed few similar reported cases in the literatures. To our knowledge, the present case is the first reporting these concomitant pathological findings.