Echocardiography

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Echocardiography

• Right Ventricular
• Systolic Function

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Evaluation of RV Systolic Function

• Quantitative Approach
• Difficult 3D reconstruction tedious and time
  consuming.
• No standard geometric formulas for volume
  calculations.

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Evaluation of RV Systolic Function

• Qualitative
• Sufficient for clinical decision making
• Several Windows
• PLAX
• PSAX
• RVIT
• Apical 4 chamber
• Subcostal 4 chamber

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Evaluation of RV Systolic Function

• In each view evaluate
• Area of RV (compare with LV)
• Shape or RV cavity
• RVWT
• Degree of motion of RVFW
• Pattern of septal motion

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Evaluation of RV Systolic Function

• RV ventricle chamber
• No simple geometric shape
• Wraps around the LV in a U-shaped manner

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Evaluation of RV Systolic Function

• Divided into 3 segments
• Inflow medial to LV
• Body and apex anterior to the LV
• Outflow superior to LV and aortic valve.

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Evaluation of RV Systolic Function

• In apical and subcostal 4 chamber views
• the RV is
• Triangular in shape broad base and narrow apex.
• Apex closer to base than LV by about 1/3 of the
  LV length

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Evaluation of RV Systolic Function
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Evaluation of RV Systolic Function
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Evaluation of RV Systolic Function
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Evaluation of RV Systolic Function
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Evaluation of RV Systolic Function

• RV Dilation
• RVOT enlarged in PLAX
• In apical and subcostal views RV will be larger
  and RV apex either closer to or encompasses the
  LV apex

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Evaluation of RV Systolic Function
Degree of Dilation RV 2-D area
Mild Enlarged but lt than LV
Moderate Enlarged and than LV
Severe Enlarged and gt than LV
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Evaluation of RV Systolic Function

• RV dilation
• Normal response of RV to volume overload
• Search for etiology
• - ASD
• - TR
• - PR
• - Long standing pressure overload

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Evaluation of RV Systolic Function

• RV hypertrophy
• RVFW gt 0.5 cm
• Normal response of RV to pressure overload
• Search for etiology
• - Pulmonary stenosis
• - Pulmonary hypertension

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Evaluation of RV Systolic Function

• RV hypertrophy
• Wall thickening also seen in
• - infiltrative cardiomyopathies
• - hypertrophic cardiomyopathy

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Evaluation of RV Systolic Function

• Pattern of Septal Motion
• Diastole
• PSAX
• RV is circular
• Normal septal curvature convex to the RV and
  concave to the LV

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Evaluation of RV Systolic Function

• Systole
• Septal thickening
• Septum moves towards the center of the LV
• Shows circular LV chamber at the end of systole

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Evaluation of RV Systolic Function

• Septal Motion
• Septum moves toward the center of mass of the
  entire heart.
• Center of mass of the entire heart is the center
  of the LV

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Evaluation of RV Systolic Function

• RV mass LV Mass
• No septal motion

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Evaluation of RV Systolic Function

• RV mass gt LV mass
• Septum moves anteriorly during systole
  (paradoxical septal motion)
• Flattens or reverses its curvature in diastole
  (2-D echo)

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Evaluation of RV Systolic Function

• Pressure Overload
• Maximum reverse curvature occurring at the end of
  systole.
• Volume overload
• Maximum reversed curvature is seen in
  mid-diastole.

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Evaluation of RV Systolic Function
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Evaluation of RV Systolic Function
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Evaluation of RV Systolic Function
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Evaluation of RV Systolic Function
SPAP RVSP 4( TRjet)2 RAP  
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Evaluation of RV Systolic Function
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Evaluation of RV Systolic Function
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Evaluation of RV Systolic Function
IVC Respiratory Change Estimated RAP mmHg
Small (lt 1.5 CM) Collapse 0 - 5
Normal ( 1.5 2.5 cm) Decrease by gt 50 5 - 10
Normal Decrease by lt 50 10 - 15
Dilated (gt 2.5 cm) Decrease by lt 50 15 - 20
Dilated with dilated hepatic veins No change gt 20
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Evaluation of RV Systolic Function

• PA velocity Curve
• Normal
• Slower acceleration
• Longer time from onset of flow to peak flow
• Rounded velocity curve

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Evaluation of RV Systolic Function

• As Pulmonary Vascular Resistance increases
• The PA velocity curve approximates the LV
  ejection curve.
• Rapid acceleration
• Short time from flow onset to maximum velocity.
• Sharper curve

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Evaluation of RV Systolic Function

• A logarithmic relation between the time from
  onset of
• flow to peak velocity and mean pulmonary arterial
  
• pressure has been constructed.

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Evaluation of RV Systolic Function
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Evaluation of RV Systolic Function
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Evaluation of RV Systolic Function
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Evaluation of RV Systolic Function

• IVRT
• Time interval between PV closure and TV opening.
• Pulmonary hypertension is associated with
  prolongation of the RV IVRT.
• Measure IVRT with M-mode or Doppler.
• Compare with Normograms.