RIGHT VENTRICULAR FUNCTION ASSESSMENT IN ECHOCARDIOGRAPHY-RIGHT VENTRICULAR SERIES PART-2

 RIGHT VENTRICULAR SERIES PART-2

 RIGHT VENTRICULAR FUNCTION ASSESSMENT


Why should we measure Right Ventricular function in the echo? The right ventricle has its unique function In our first part of Right Ventricular series(RV SERIES) we discussed how to quantify Right Ventricular size in echo




Before going to the lecture we have to know there is some limitation for assessing Right Ventricle in echo because of the crescentic shape, we had already discussed this in our first part of RV series.


Right ventricular function is mainly assessed by 5 methods:


Tricuspid annular plane systolic excursion

fractional area change

tei index

s prime

visual estimation of RV free wall 

tricuspid annular motion



TAPSE 




TAPSE is measured from Right Ventricle m mode. In apical four-chamber view m mode cursor placed on the junction of tricuspid valve plane with the RV free wall. Tapse is the difference in displacement during diastole and systole, an abnormal excursion is less than 1.6 centimetre, normal value is in the range of 1.5 to 1.6





F A C(FRACTIONAL AREA CHANGE)


F A C is calculated by tracing right ventricular area including apex and lateral wall during systole and diastole.FAC less than 35% indicates right ventricular systolic dysfunction



tei index(Myocardial performance index)


tei index provides the global RV function. It is a measure of both systolic and diastolic function. It is a ratio of isovolumic time to ejection time. A value more than 0.40 by pulse wave and more than 0.5 by tissue doppler indicates Right Ventricular dysfunction.






This is an example of how to do a tei index or myocardial performance by the echo. First, record tissue doppler from tricuspid annulus measure valve closure to opening time and from parasternal short-axis pulmonary valve level. Ejection time

s prime is the measure of RV systolic function, a value less than 10 cm/sec indicates RV dysfunction


For measuring RV dysfunction pulse wave doppler of the tricuspid valve, tissue doppler of lateral tricuspid annulus, pulse wave doppler of hepatic veins and inferior vena cavae should be measured.

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