Sail sound is heard in – Correct answer: d) Ebstein’s anomaly
Sail sound is the loud tricuspid component of first heart sound due to closing of the large anterior (sail like) tricuspid leaflet. In Ebstein’s anomaly, the septal and posterior leaflets are smaller and displaced far into the right ventricle. Anterior leaflet is not displaced, but larger to coapt with the displaced posterior and septal leaflets. The portion of right ventricle between displaced leaflets and the non displaced leaflet is known as ‘atrialized right ventricle’. The pressure in this region is atrial as it is proximal to the tricuspid valve closure point. Hence the functional right ventricle is only a small distal portion.