Right Ventricle

RV size (Normal, Mild, Mod, Sev)

- Normal: Smaller than LV

- Mildly dilated: Appears slightly large >2/3 LV but still smaller than LV, and apex is still formed by the LV

- Moderately dilated: RV is of a similar size to LV, and the apex may be shared by RV and LV

- Severely dilated: RV is larger than LV. RV apex forms the apex

What is FAC?

The percentage of area change of the RV in systole and diastole.

What is TAPSE

Tricuspid Annular Plane Systolic Excursion.

It measures the longitudinal function of the RV at the basal segment.

RV strain normal value

>-23% (-24 etc)

PASP

Without PS or RVOTO using Bernoulli equation:

- RVSP = PASP

With PS and RVOTO

PASP = RVSP - systolic pressure gradient across the PV

cor pulmonale

McConnel's sign

Akinesis of the RV mid free wall with sparing of the RV apex.

Limitations when assessing RV function

- Cannot image the entire RV in one view

- There is a lot of trabeculations which makes the endocardial definitions difficult to define when doing FAC

- RV has radial, longitudinal, and circumferential shortening, they're all independent movements and hard to visualise on echo which is why sometimes TAPSE and S' are discordant.

Extension of Criteria in Echo for RV dysfunction.

- Pleural effusion is a really common complication when there is PHTN and RV dysfunction.

- RV wall strain

- RV wall thickness for hypertrophy

- 3D RV function

Pulmonary Embolism Signs

- RV dilatation with impaired systolic function.

- Dilation of the PA and branches

- D- shape Flattening of IVS

- Mid systolic notching of RVOT trace

- Dilatation of the IVC

- Variable TR severity

- 60/60 sign: RVSP ≤60 mmHg and short pulmonary acceleration time ≤60 ms

- McConnels sign (akinesis of the RV mid free wall with sparing of the RV apex)