Consult the medical resource doctors trust

UpToDate is one of the most respected medical information resources in the world, used by over 360,000 doctors and thousands of patients to find answers to medical questions.

  • Content written by a faculty of over 4,000 physicians from leading medical institutions
  • Unbiased: free of advertising or pharmaceutical funding
  • Evidence-based treatment recommendations
  • Continuously updated to incorporate new medical findings

Echocardiographic evaluation of the right ventricle

INTRODUCTION

Imaging the right ventricle is an essential and highly informative portion of the comprehensive echocardiographic evaluation. Patients with an abnormality of the left heart on echocardiographic examination often have concomitant right ventricular abnormalities.

The normal right ventricle can be recognized by a number of echocardiographic features. Its free wall is <0.4 mm thick, its apex is heavily trabeculated and dominated by the septal marginal trabeculation or moderator band, and its most active contraction occurs along its longitudinal axis. This latter feature creates a striking annular plane motion recognized best in the apical four chamber and subcostal views. In all views, the body of the right ventricle is visually subordinate to the companion left ventricle.

ECHOCARDIOGRAPHIC EVALUATION OF THE RIGHT VENTRICLE

Evaluation of the right ventricle (RV) involves evaluation of wall thickness, shape, ventricular cavity size and content, as well as regional and global contractile function.

Wall thickness — Right ventricular hypertrophy is recognized by inspecting the wall of the right ventricular outflow tract in the precordial views, the free wall in the apical view, and the diaphragmatic wall in the subcostal view. Generally, the RV free wall in diastole is approximately 3 to 4 mm thick; if it exceeds 5 mm it is considered hypertrophied (figure 1A-B) [1,2].

Right ventricular wall thickness, when inspected or measured in the subcostal view, allows differentiation of the wall thickness from cavity trabeculations [3]. Contrast enhancement of M-mode or two dimensional images can aid in measuring wall thickness [4,5].
To continue reading this article you need to subscribe.

Read the rest of this article and others like it

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use (click here) ©2010 UpToDate, Inc.
References Top
  1. Schnittger, I, Gordon, EP, Fitzgerald, PJ, Popp, RL. Standardized intracardiac measurements of two-dimensional echocardiography. J Am Coll Cardiol 1983; 2:934.
  2. Sahn, DJ, DeMaria, A, Kisslo, J, Weyman, A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978; 58:1072.
  3. Cooper, MJ, Teitel, DF, Silverman, NH, Enderlein, M. Comparison of M-mode echocardiographic measurement of right ventricular wall thickness obtained by the subcostal and parasternal approach in children. Am J Cardiol 1984; 54:835.
  4. Lange, PE, Seiffert, PA, Pries, F, et al. Value of image enhancement and injection of contrast medium for right ventricular volume determination by two-dimensional echocardiography in congenital heart disease. Am J Cardiol 1985; 55:152.
  5. Wann, LS, Stickels, KR, Bamrah, VS, Gross, CM. Digital processing of contrast echocardiograms: a new technique for measuring right ventricular ejection fraction. Am J Cardiol 1984; 53:1164.
  6. Kjaergaard, J, Sogaard, P, Hassager, C. Quantitative echocardiographic analysis of the right ventricle in healthy individuals. J Am Soc Echocardiogr 2006; 19:1365.
  7. Lang, RM, et al. Recommendations for Chamber Quantification. J Am Soc Echo 2005;1440.
  8. Gopal, AS, Chukwu, EO, Iwuchukwu, CJ, et al. Normal values of right ventricular size and function by real-time 3-dimensional echocardiography: comparison with cardiac magnetic resonance imaging. J Am Soc Echocardiogr 2007; 20:445.
  9. Kaul, S, Tei, C, Hopkins, JM, Shah, PM. Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J 1984; 107:526.
  10. Isaaz, K, Munoz del Romeral, L, Lee, E, Schiller, NB. Quantitation of the motion of the cardiac base in normal subjects by Doppler echocardiography. J Am Soc Echocardiogr 1993; 6:166.
  11. Himelman, RB, Struve, Brown, JK, et al. Improved recognition of cor pulmonale in patients with severe chronic obstructive pulmonary disease. Am J Med 1988; 84:891.
  12. Silverman, NH, Hudson, S. Evaluation of right ventricular volume and ejection fraction in children by two-dimensional echocardiography. Pediatr Cardiol 1983; 4:197.
  13. Lewis, JF, Webber, JD, Sutton, LL, et al. Discordance in degree of right and left ventricular dilation in patients with dilated cardiomyopathy: recognition and clinical implications. J Am Coll Cardiol 1993; 21:649.
  14. Sun, JP, James, KB, Yang, XS, et al. Comparison of mortality rates and progression of left ventricular dysfunction in patients with idiopathic dilated cardiomyopathy and dilated versus nondilated right ventricular cavities. Am J Cardiol 1997; 80:1583.
  15. Phoon, CK, Silverman, NH. Conditions with right ventricular pressure and volume overload, and a small left ventricle: "hypoplastic" left ventricle or simply a squashed ventricle?. J Am Coll Cardiol 1997; 30:1547.
  16. Kerr, AJ, Chia, KKM, Buck, T, et al. Bed tilt as an effort-independent maneuver to improve patent foramen forman ovale assessment by transthoracic contrast echocardiography. Am J Cardiol 2001; 88:94.
  17. Simonson, JS, Schiller, NB. Sonospirometry: a new method for noninvasive estimation of mean right atrial pressure based on two-dimensional echographic measurements of the inferior vena cava during measured inspiration. J Am Coll Cardiol 1988; 11:557.
  18. Ristow, B, Ali, S, Ren, X, et al. Elevated pulmonary artery pressure by Doppler. J Am Coll Cardiol 2007; 49:43.
  19. McConnell, MV, et al. Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism. Am J Cardiol 1996; 78:469.
  20. Daniels, LB, Krummen, DE, Blanchard, DG. Echocardiography in pulmonary vascular disease. Cardiol Clin 2004; 22:383.
  21. Abbas, AE, Fortuin, FD, Schiller, NB, et al. A simple method for noninvasive estimation of pulmonary vascular resistance. J Am Coll Cardiol 2003; 41:1021.
  22. Stein, JH, Neumann, A, Preston, LM, et al. Echocardiography for hemodynamic assessment of patients with advanced heart failure and potential heart transplant recipients. J Am Coll Cardiol 1997; 30:1765.
  23. Goldberger, JJ, Himelman, RB, Wolfe, CL, Schiller, NB. Right ventricular infarction: recognition and assessment of its hemodynamic significance by two-dimensional echocardiography. J Am Soc Echocardiogr 1991; 4:140.
  24. Sharpe, DN, Botvinick, EH, Shames, DM, et al. The noninvasive diagnosis of right ventricular infarction. Circulation 1978; 57:483.
  25. Acquatella, H, Schiller, NB, Puigbo, JJ, et al. Value of two-dimensional echocardiography in endomyocardial disease with and without eosinophilia. A clinical and pathologic study. Circulation 1983; 67:1219.
  26. Acquatella, H, Schiller, NB, Puigbo, JJ, et al. M-mode and two-dimensional echocardiography in chronic Chagas' heart disease. A clinical and pathologic study. Circulation 1980; 62:787.
  27. Manyari, DE, Klein, GJ, Gulamhusein, S, et al. Arrhythmogenic right ventricular dysplasia: a generalized cardiomyopathy?. Circulation 1983; 68:251.
  28. Marcus, FI, Fontaine, G. Arrhythmogenic right ventricular dysplasia/cardiomyopathy: a review. Pacing Clin Electrophysiol 1995; 18:1298.
  29. Chapoutot, L, Nazeyrollas, P, Metz, D, et al. Floating right heart thrombi and pulmonary embolism: diagnosis, outcome and therapeutic management. Cardiology 1996; 87:169.
  30. Ports, TA, Schiller, NB, Strunk, BL. Echocardiography of right ventricular tumors. Circulation 1977; 56:439.
  31. Lee, CC, Celik, C, Lajos, TZ. Excision of papillary fibroelastoma arising from the septal leaflet of the tricuspid valve. J Card Surg 1995; 10:589.
  32. Scobbo, RR, Chung, EK. Cardiac tumors. Postgrad Med 1974; 56:138.
  33. Nellessen, U, Daniel, WG, Matheis, G, et al. Impending paradoxical embolism from atrial thrombus: correct diagnosis by transesophageal echocardiography and prevention by surgery. J Am Coll Cardiol 1985; 5:1002.
  34. Rosenzweig, MS, Nanda, NC. Two-dimensional echocardiographic detection of circulating right atrial thrombi. Am Heart J 1982; 103:435.
  35. Felner, JM, Churchwell, AL, Murphy, DA. Right atrial thromboemboli: clinical, echocardiographic and pathophysiologic manifestations. J Am Coll Cardiol 1984; 4:1041.
  36. Goldberg, SM, Pizzarello, RA, Goldman, MA, Padmanabhan, VT. Echocardiographic diagnosis of right atrial thromboembolism resulting in massive pulmonary embolization. Am Heart J 1984; 108:1371.
  37. Cameron, J, Pohlner, PG, Stafford, EG, et al. Right heart thrombus: recognition, diagnosis and management. J Am Coll Cardiol 1985; 5:1239.
  38. Armstrong, WF, Feigenbaum, H, Dillon, JC. Echocardiographic detection of right atrial thromboembolism. Chest 1985; 87:801.
  39. Higgins, JR, Strunk, BL, Schiller, NB. Diagnosis of paradoxical embolism with contrast echocardiography. Am Heart J 1984; 107:375.
  40. Ryan, J, Lasorda, D, Spero, J, Dianzumba, S. Thrombolysis of right atrial thrombus with pulmonary embolism in anticardiolipin antibody syndrome. Am Heart J 1995; 130:905.
  41. Hausmann, D, Mugge, A, Daniel, WG. Identification of patent foramen ovale permitting paradoxic embolism. J Am Coll Cardiol 1995; 26:1030.
  42. Manthey, J, Munderloh, KH, Mautner, JP, et al. Popliteal venous aneurysm with pulmonary and paradoxical embolization. Vasa 1994; 23:264.
  43. Reyes-Iglesias, Y, Kelley, RE, Bilsker, MS, et al. Unmasking a patent foramen ovale during recurrent paradoxical cerebral embolism. South Med J 1994; 87:84.
  44. DiCarlo, LA Jr, Schiller, NB, Herfkens, RL, et al. Noninvasive detection of proximal pulmonary artery thrombosis by two-dimensional echocardiography and computerized tomography. Am Heart J 1982; 104:879.
  45. Fisher, DC, Fisher, EA, Budd, JH, et al. The incidence of patent foramen ovale in 1,000 consecutive patients. A contrast transesophageal echocardiography study. Chest 1995; 107:1504.
  46. Stone, DA, Godard, J, Corretti, MC, et al. Patent foramen ovale: association between the degree of shunt by contrast transesophageal echocardiography and the risk of future ischemic neurologic events. Am Heart J 1996; 131:158.
  47. Finet, G, Bozio, A, Frieh, JP, et al. Herniation of the left atrial appendage through a congenital partial pericardial defect. Eur Heart J 1991; 12:1148.
white circle LOG IN
white circle DEMO