DK2985_C000 1..28 - AlSharqia Echo Club

Global Ventricular Function and Hemodynamics 197(A)(B)LIVERTVRVRAIVCHEPATICVEINSVC2D:RA and RV sizeTricuspid annular motion(C)(D)PW Doppler:Hepatic vein interrogationTissue Doppler:Tricuspid annular velocityLIVERIVCRAHEPATICVEINIVCLIVERFigure 9.18 Evaluation of systolic and diastolic function of the right ventricle (RV). (A, B) Transgastric right ventricular long axis.Right chamber size is evaluated. Pulsed-wave (PW) Doppler interrogation of the hepatic vein and tissue Doppler evaluation of the tricuspidannulus. (C, D) Alternative deep esophageal 08 position with rightward rotation to perform PW Doppler interrogation of thehepatic vein (IVC, inferior vena cava; RA, right atrium; SVC, superior vena cava; TV, tricuspid valve).PRE-CPB(A) HVF(B)TAV(C)SDARE tA tLARARVLVPOST-CPB(D) HVF(E)TAV(F)SDAREtAtE tA tFigure 9.19 Systolic and diastolic function of the right ventricle (RV) in a 65-year-old man with previous inferior myocardial infarctionscheduled for coronary revascularization. (A–C) Before cardiopulmonary bypass (CPB): the ejection fraction of the left ventricle(LV) is 20% with a low cardiac index of 1.5 L/min per m 2 . (A) Pulsed-wave Doppler hepatic venous flow (HVF) shows systolic flowS predominance. (B) Tissue Doppler of tricuspid annular velocities (TAV) shows a E t /A t ratio ,1 (E t ¼ 5.7 and A t ¼ 11.5 cm/sec).Both suggest mild diastolic dysfunction of the RV. (C) The fractional area change (FAC) of the RV is 34%. (D–F) Post-CPB. (D)The HVF showed new blunting of the systolic flow S. (E) The TAV are increased with a similar ratio (E t ¼ 7.1 and A t ¼ 12.1 cm/sec).This suggests decreased RV compliance. (F) Right ventricular FAC increased to 48% consistent with the surgeon’s visual appreciationof improved right ventricular function. Upon arrival to the intensive care unit, the cardiac index was 3.0 L/min per m 2 (AR, atrial reversal;EDA, end-diastolic area; ESA, end-systolic area; LA, left atrium; RA, right atrium).