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Echocardiography

Echocardiography. Right Ventricular Systolic Function. Evaluation of RV Systolic Function. Quantitative Approach Difficult – 3D reconstruction tedious and time consuming. No standard geometric formulas for volume calculations. Evaluation of RV Systolic Function. Qualitative

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Echocardiography

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  1. Echocardiography Right Ventricular Systolic Function

  2. Evaluation of RV Systolic Function Quantitative Approach • Difficult – 3D reconstruction tedious and time consuming. • No standard geometric formulas for volume calculations.

  3. Evaluation of RV Systolic Function Qualitative • Sufficient for clinical decision making Several Windows • PLAX • PSAX • RVIT • Apical 4 chamber • Subcostal 4 chamber

  4. 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

  5. Evaluation of RV Systolic Function RV ventricle chamber • No simple geometric shape • Wraps around the LV in a U-shaped manner

  6. 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.

  7. 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

  8. Evaluation of RV Systolic Function

  9. Evaluation of RV Systolic Function

  10. Evaluation of RV Systolic Function

  11. Evaluation of RV Systolic Function

  12. 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

  13. Evaluation of RV Systolic Function

  14. Evaluation of RV Systolic Function RV dilation • Normal response of RV to volume overload • Search for etiology: - ASD - TR - PR - Long standing pressure overload

  15. Evaluation of RV Systolic Function RV hypertrophy • RVFW > 0.5 cm • Normal response of RV to pressure overload • Search for etiology: - Pulmonary stenosis - Pulmonary hypertension

  16. Evaluation of RV Systolic Function RV hypertrophy • Wall thickening also seen in: - infiltrative cardiomyopathies - hypertrophic cardiomyopathy

  17. 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

  18. 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

  19. 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

  20. Evaluation of RV Systolic Function RV mass = LV Mass • No septal motion

  21. Evaluation of RV Systolic Function RV mass > LV mass • Septum moves anteriorly during systole (paradoxical septal motion) • Flattens or reverses its curvature in diastole (2-D echo)

  22. 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.

  23. Evaluation of RV Systolic Function

  24. Evaluation of RV Systolic Function

  25. Evaluation of RV Systolic Function

  26. Evaluation of RV Systolic Function SPAP = RVSP = 4( TRjet)2 + RAP

  27. Evaluation of RV Systolic Function

  28. Evaluation of RV Systolic Function

  29. Evaluation of RV Systolic Function

  30. Evaluation of RV Systolic Function PA velocity Curve Normal • Slower acceleration • Longer time from onset of flow to peak flow • Rounded velocity curve

  31. 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

  32. 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.

  33. Evaluation of RV Systolic Function

  34. Evaluation of RV Systolic Function

  35. Evaluation of RV Systolic Function

  36. 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.

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