Essential Echocardiography by Timothy M. Maus Sonia Nhieu & Seth T. Herway

Author:Timothy M. Maus, Sonia Nhieu & Seth T. Herway
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Additionally two-dimensional measurements of the RV in the ME four-chamber view can be utilized to assess RV size. The RV basal dimension [measure of the width of the TV annulus in the ME four-chamber view] ranges from 2 to 2.8 cm with 4.0 cm as the reference limit of a severely dilated annulus [18]. Longitudinal measurements from the tricuspid valve plane to the RV apex range from 7.1 to 7.9 cm, with a 9.2 cm measurement indicating a severely dilated RV [19, 20].

Right Ventricular Hypertrophy

Echocardiographic evaluation of RV wall thickness may also serve to evaluate global RV performance because conditions of RV pressure overload cause compensatory right ventricular hypertrophy (RVH). This increase in RV myocardial mass is an effort to maintain cardiac output in the presence of increased PVR.

TEE evaluation of RV wall thickness typically assesses the lateral RV free wall thickness. Normally, the RV is thin-walled with RV free wall thickness (RVWT) approximately half the wall thickness of the LV, measuring <5 mm at end-diastole. RVH may be diagnosed when the RVWT is >5 mm, while RVWT exceeding 10 mm is considered severe hypertrophy (Fig. 8.2). The best views to measure the RV free wall are in the ME four-chamber, ME RV inflow–outflow, or TG RV inflow views. Measurements of RVWT occur during myocardial relaxation (diastole) and must exclude the epicardial fat layer. Additionally, the moderator band is usually more prominent in patients with RV hypertrophy and is often visualized near the RV apex (Fig. 8.3; Video 8.2).

Fig. 8.2A midesophageal four-chamber view of a patient with chronic pulmonary hypertension and resultant right ventricular hypertrophy (green arrow)

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