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Right Ventricule Evaluation

The right ventricle is crescent shape that wraps along the LV. This adds complexity to the quantification of its size and function

Our focus here on cardiac ultrasound is to be able to determine RV size and function in a qualitative or semiquantitative way in an interrogation that is conducted without the requirement of performing specific measurements. We will explore some qualitative appreciation of sizes and function of the RV and go beyond the scope of FoCUS to be give you numerical data you can use clinically. 

1. Visual Global Assessment

Comparing right ventricular dimensions to left ventricle dimensions is an important technique to assess function. The ideal views for this technique are apical 4-chamber and subcostal 4-chamber views. The RV internal diameter should not be more than 2/3 the size of the LV, and it should not extend more than 2/3 to the apex of the LV. Changes in the size of the RV as well as displacement of the tricuspid valve can be used to evaluate function. Linear measurements are very useful to determine function (see later section)

Normal RV

Normal RV Dimensions and Function

-RV internal diameter should be <2/3 of the size of the LV

-RV should extend <2/3 to the apex of the LV

-The interventricular septum should not be flattened or D shaped which is indicative of RV pressure or volume overload

-The Systolic eccentricity index (EI) is a  measure of RV overload. At end systole D1 bisects pap muscles and D2 is orthogonal. EI is D2/D1. Normal EI is 1 and dyskinesia is present when EI>1

D2

D1

RV DD1

Dilated and

Depressed RV

On these clips: 

-Enlarged RV. The RV is bigger in size than the LV

-Depressed RV

-On diastole the septum is pushed towards the LV indicating fluid overload.

-Enlarged RA

Dilated and

Depressed RV

-Enlarged RV. The RV is bigger in size than the LV

-Depressed RV

-On systole and diastole the septum is pushed towards the LV indicating fluid and pressure overload.

-Enlarged RA

RV DD2
RV M Mode

Dilated and

Depressed RV

-Enlarged RV. The RV is bigger in size than the LV

-On systole and diastole the septum is pushed towards the LV indicating fluid and pressure overload. More evident on diastole.

-Enlarged RA

-TAPSE <17mm (see below)

Comparison of RV Depression

-On the left the RV diameter does not appear enlarged and function seems mildly depressed.

-On the right, the RV is enlarged and depressed with both fluid and pressure overload. The free wall of the RV does not appear to move but the apex does (McConnell's sign)