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EACVI Echo Handbook - sample

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Chapter 9 Right Heart

Chapter 9 Right Heart Function and Pulmonary Artery Pressure 9.1 RV function 380 Right chamber imaging and views 380 RV measurements 381 RV function 382 Causes of RV dysfunction 382 Measures of RV function 383 Measures of RV function—longitudinal measures 384 Tricuspid annular plane systolic velocity (s’) 384 Measures of RV function—combined measures 385 Right atrial (RA) measurements 388 9.2 RV volume overload 389 Aetiology 389 Specific echocardiographic findings 389 9.3 RV pressure overload 391 Aetiology 391 How to measure RV pressures 391 RV pressures 392 Echocardiographic findings in acute PE (pulmonary embolism) 392 Echo findings in chronic PAH and secondary PH 393 Exercise testing for pulmonary hypertension 393 Reference values 394 Suggested reading 396 379

Chapter 9 Right Heart Function and Pulmonary Artery Pressure RV pressures Alternative measures of increased RV pressures are: ◆◆ Raised RVEDP calculated from the pulmonary regurgitation velocity on CW Doppler (Fig. 9.3.2) ◆◆ Short pulmonary acceleration time (time from start of ejection to peak flow) (Fig. 9.3.3) ◆◆ Notched RV outflow through pulmonary valve by PW Doppler (Fig. 9.3.4) Echocardiographic findings in acute PE (pulmonary embolism) ◆◆ A range of pulmonary vascular and RV findings may be observed. Normal PASP/RV function does not exclude PE ◆◆ PASP may be elevated and RV function may be impaired. Most frequently, reduced RV contraction occurs with little or no RV dilation ◆◆ McConnell’s sign (akinesis of the mid RV free wall) and other regional RV dysfunction are common and may be identified qualitatively or with strain/strain rate ◆◆ Combination of PAT < 60 ms and PASP < 60 mmHg (‘60/60 sign’) is relatively specific for PE + 11 mmHg + RAP Fig. 9.3.2 Raised RVEDP Fig. 9.3.3 Short pulmonary acceleration time short pulmonary acceleration time notched RV outflow Doppler trace Fig. 9.3.4 Notched RV outflow through pulmonary valve by PW Doppler 392

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