Diastolic paradoxical septal motion in Ebstein anomaly

A 36-year-old male was presented to our outpatient clinic with the chief complaint of progressive dyspnea. His symptoms worsened over the last 6 months, and the degree of dyspnea on admission corresponded to New York Heart Association grade III–IV. In his past medical history, he had been diagnosed as Ebstein’s anomaly 10 years prior. Upon physical examination, he had also a holosystolic murmur at the subxiphoid area. Transthoracic echocardiography showed that the interventricular septum was significantly deformed, resulting in abnormal motion of the basal septum toward the left ventricular outflow tract (LVOT) dur ing diastole (Fig. 1a and Video 1). There was no turbulent flow and gradient on LVOT (Fig. 1b). Tricuspid septal leaflet annular attachment had been displaced toward to apex and right ventricular outflow tract (Fig. 1c and Video 2). The axial sections of T2- weighted magnetic resonance images demonstrated paradoxical septal motion toward LVOT (Fig. 1d and 1e, Video 3); also, coronal sequences showed impaired left ventricular diastolic filling (Fig. 1f and Video 4). Surgical management was recommended, and the patient underwent plication of atrialized right ventricle and tricuspid valvuloplasty.