Right Ventricle

This is also straying into ninja territory, as it is often difficult to see well. Commonly neglected in echos, the RV is of great importance in critical care. See the later pages on pulmonary hypertension and critical care for more information.

RV dimensions

RV should be 2/3 size LV. If same size then dilated.
Moderator band seen in apex.
Trabeculated.

2D end diastole:
A4C

  • Basal and mid diameter.
  • Length.

PSAX aortic level

  • RVOT diameter at AV and PV annulus level.
  • Main pulmonary artery diameter (width distal to PV annulus).

Wall thickness can be measured in PLAX or subcostal views. Normal <5mm.
Area trace for volume.

RV1


RV function

Fractional area change

Trace RV diastole and systole. This is just for area change – volume is not calculated as the RV is crescent shaped so Simpson’s disc method would be inaccurate.

(RVEDa – RVESa) / RVEDa x 100


TAPSE

A4C
M-mode through lateral TV annulus.
Measure vertical displacement.

Tei index

This is the myocardial performance index, takes into account systolic and diastolic function and is independent of HR. It is isovolaemic contraction and relaxation time divided by ejection time.
Can be used for LV too for which the normal value is also <0.4.
Measure RV systole by PW TV inflow (measure from end forward flow to start of next forward flow). This comprises IVCT, ET and IVRT. This = a
PW forward flow though PV and measure duration of ejection (start to end single forward flow trace). 

This = b

Tei index = a – b / b

The vasoactive substances secreted by carcinoid tumours typically affect the right heart with fibrous endocardial plaques on valves and chambers.

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