Echocardiographic Evaluation of the Right Heart

Abstract

The appropriate use of echocardiography may reduce the need for invasive diagnostic cardiac procedures. The right side of the heart has recently gained interest among cardiologists as it became clear that abnormalities of the right heart morphology and function are associated with increased morbidity and mortality. Echocardiography is easy to perform, relatively cheap, readily available and do not pose the risk of ionizing radiation. Conventional 2D and, more recently, 3D echocardiography provides pertinent anatomic and physiologic information about the right side of the heart. Because of the advantages and simplicity of echocardiography it continues to be an excellent tool for evaluating the structure and function of the right side of the heart. This review outlines the uses of echocardiography in evaluating the right heart structure and function.

Keywords: Echocardiography; Right heart; Right ventricle.

Fig. 1. Echocardiographic views most frequently used to assess the structure and function of the right heart. Apical four chamber view (A). Parasternal short axis view at the level of the aortic valve showing the right atrium (RA), right ventricle (RV), right ventricular outflow tract, pulmonary valve and main pulmonary artery (B). Parasternal short axis view at the level of the papillary muscles (C). Subcostal four chamber view (D). AV: aortic valve, LA: left atrium, LV: left ventricle, PA: pulmonary artery, TV: tricuspid valve.

Fig. 2. Echocardiographic images of right heart abnormalities. Atrial septal defect in a 53-year-old woman with transient ischemic attack who declined closure (A, transesophageal echocardiography, 0 degree, arrow pointing at interatrial septum); Ebstein's anomaly in a 41-year-old man with severe tricuspid regurgitation, right atrial enlargement (B, apical four chamber view, arrow showing severely enlarged right atrium), right ventricular dysfunction and right heart failure who subsequently underwent tricuspid valve repair, right atrial reduction and maze procedure; pulmonary valve stenosis in a 38-year-old woman who had congenital pulmonic valve stenosis subsequently corrected by balloon valvuloplasty; Doppler showing high velocities across the valve (C, transesophageal echocardiography, 0 degree, arrow pointing at pulmonary valve plane); and right atrial thrombus (measuring 2 cm in length) in a 30-year-old woman who had systemic lupus erythematosus and end stage renal disease with just removed status of central venous catheter (D, transesophageal echocardiography, 105 degree, arrow pointing at the end of the pedunculated thrombus).