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Review
. 2022 May 13;1(3):136-157.
doi: 10.1016/j.cjcpc.2022.05.002. eCollection 2022 Jun.

Echocardiographic Assessment of Right Ventricular Function in Paediatric Heart Disease: A Practical Clinical Approach

Kandice Mah  1 , Luc Mertens  2
Affiliations
Review

Echocardiographic Assessment of Right Ventricular Function in Paediatric Heart Disease: A Practical Clinical Approach

Kandice Mah et al. CJC Pediatr Congenit Heart Dis. .

Abstract
in English, French

As the right ventricle (RV) plays an integral role in different paediatric heart diseases, the accurate assessment of RV size and function is essential in the diagnosis, management, and prognostication of congenital and acquired cardiac lesions. Yet, echocardiographic evaluation of the RV is challenging because of its complex and variable morphology, its different physiology compared with the left ventricle, and its capability to adapt to different loading conditions associated with congenital and acquired heart diseases within certain ranges. Reliable echocardiographic detection of RV systolic and diastolic dysfunction remains challenging while important for patient management. This review provides an updated, practical approach to assessing RV function in structurally normal hearts and in children with common congenital heart defects and in those with pulmonary hypertension. We also review the impact of tricuspid valve function on RV functional parameters. There is no single functional RV parameter that uniquely describes RV function; instead a combination of different parameters is recommended in clinical practice. Qualitative and quantitative analysis of RV function will be reviewed including more recent techniques such as speckle tracking and 3D echocardiography.

Étant donné que le ventricule droit (VD) joue un rôle déterminant dans diverses cardiopathies pédiatriques, l’évaluation précise de sa taille et de sa fonction s’avère essentielle pour le diagnostic, la prise en charge et le pronostic des lésions cardiaques congénitales et acquises. Pourtant, il s’avère difficile d’effectuer une évaluation échocardiographique du VD en raison de sa morphologie complexe et variable, des caractéristiques physiologiques qui le distingue du ventricule gauche et de sa capacité à s’adapter dans une certaine mesure à différentes conditions de charge associées aux cardiopathies congénitales et acquises. La détection échocardiographique fiable des dysfonctions systolique et diastolique du VD représente encore un défi, tout en étant importante pour la prise en charge des patients. Le présent article de synthèse propose une approche pratique et actualisée pour l’évaluation de la fonction ventriculaire droite en l’absence d’anomalie structurelle cardiaque, de même qu’en présence d’anomalies cardiaques congénitales courantes ou d’hypertension pulmonaire chez les enfants. Nous examinons également l’effet de la fonction valvulaire tricuspide sur les paramètres de la fonction ventriculaire droite. Aucun paramètre fonctionnel pris isolément ne suffit à décrire la fonction ventriculaire droite; le recours à une combinaison de différents paramètres est plutôt recommandé en pratique clinique. L’analyse qualitative et quantitative de la fonction ventriculaire droite sera abordée, y compris des techniques plus récentes telles que l’échocardiographie de suivi des marqueurs acoustiques (speckle tracking) et l’échocardiographie tridimensionnelle.

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Figures

Figure 1
Figure 1
Right ventricular (RV) measurements in systole and diastole., Standardized measurement locations of the RV in the RV-centric 4-chamber view. RVEDa, right ventricular end-diastolic mid-ventricular area; RVEDb, right ventricular end-diastolic basal width; RVEDL, right ventricular end-diastolic length; RVEDm, right ventricular end-diastolic mid-ventricular width; RVESa, right ventricular end-systolic mid-ventricular area; RVESb, right ventricular end-systolic basal width; RVESL, right ventricular end-systolic length; RVESm, right ventricular end-systolic mid-ventricular width.
Figure 2
Figure 2
Overview of methods for RV systolic function. CMR, cardiac MRI; HR, heart rate; MPI, myocardial performance index; PHTN, pulmonary hypertension; PW, pulse-wave; TOF, tetralogy of Fallot; TV, tricuspid valve.
Figure 3
Figure 3
Tricuspid valve (TV) S′ by age., TV S′ and E′ of the right ventricular free wall and medial wall. Normalized by age from Roberson et al. and Eidem et al.Black line: mean, blue line: +2SD.
Figure 4
Figure 4
Right ventricular (RA) measurements. Right atrial area (area enclosed by the purple line) is performed at end ventricular systole by tracing from the tricuspid valve annular plane, along the interatrial septum (IAS), superior RA, and anterolateral wall. Right atrial long axis (major dimension, green line) is measured from the mid-tricuspid valve annulus to the superior right atrial wall, parallel to IAS. Right atrial transverse axis (minor dimension, blue line) is measured from the mid-anterolateral wall to the mid-IAS. Right atrial volume = 0.85(RA area)2/(green major dimension).
Figure 5
Figure 5
Right end-diastolic forward flow by echocardiography. Restrictive physiology of the right ventricle can be assessed by pulse wave Doppler of the main pulmonary artery mid-way between the pulmonary valve and pulmonary artery bifurcation. A restrictive right ventricular has antegrade end-diastolic flow in the MPA from atrial contraction (arrow).
Figure 6
Figure 6
Additional pulmonary hypertension (PH) assessment.,,
See this image and copyright information in PMC

References

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