C9. An Extremely Rare Dual Congenital Disorder of The Heart: Aberrant Tendinous Chords with Tethering of The Tricuspid Leaflet Associated with Wolff-Parkinson-White Syndrome

Aberrant tendinous chords with tethering of the tricuspid leaflets is a rare congenital etiology of tricuspid regurgitation (TR), defined as abnormal insertion of tendinous cords at the clear zone of the tricuspid leaflet and connect to the endocardium instead of the papillary muscles. Wolff-Parkinson-White (WPW) syndrome defined as a congenital condition involving additional conductive cardiac tissue between the atria and the ventricles that provides a pathway for a reentrant tachycardia circuit. Ebstein's anomaly (EA) is the most commonly occurring congenital abnormality that caused TR associated with the WPW. Until now, there is no case report of aberrant tendinous chords with tethering of the tricuspid leaflets that associated with WPW.

A 26-year-old female with history of recurrent palpitation she was given was referred to our hospital. Resting ECG revealed sinus rhythm with delta wave suggesting diagnostic of WPW. On physical examination we found loud systolic murmur on left lower sternal border. Echocardiography examination revealed dilated right atrial and right ventricle, severe tricuspid regurgitation with restricted septal TV caused by aberrant tendinous chords. No apical displacement of tricuspid leaflet >8 mm/m2 excluding the diagnosis of EA.

Both WPW and aberrant tendinous chords with tethering of the tricuspid leaflet are rare congenital disorder of the heart. EA is most common congenital TR associated with WPW, there are rarely reported other congenital TR associated with WPW. This case illustrates extremely rare case where we found both WPW and Aberrant Tendinous Chords.