R ight ventricular (RV) volumes and ejection fraction (EF)are important determinants of survival in patients with myocardial infarction, 1 systolic heart failure, 2-4 congenital heart disease, 5 and pulmonary arterial hypertension.6 Clinical Perspective on p 710Cardiac magnetic resonance (CMR) is the current gold standard for quantitation of RV geometry and function, but its widespread use is limited by costs, time consumption, and contraindications, making it unsuitable for patient screening or monitoring on large scale.One of the major breakthroughs of transthoracic threedimensional echocardiography (3DE) is the ability to measure RV volumes and EF, otherwise not feasible by standard two-dimensional (2D) echocardiography. 7 However, recent recommendations for RV quantitation 8 indicated that limited normative data are currently available for 3DE and, despite significant differences by age and sex for RV geometry and function were identified by CMR, 9 no reliable age-or sexspecific reference values can be recommended at present for 3DE. Paralleling the findings obtained with CMR, 9 we hypothesized that RV volumes and EF measured by 3DEBackground-Right ventricular (RV) volumes and ejection fraction (EF) vary significantly with demographic and anthropometric factors and are associated with poor prognosis in several cardiovascular diseases. This multicenter study was designed to (1) establish the reference values for RV volumes and EF using transthoracic three-dimensional (3D) echocardiography; (2) investigate the influence of age, sex, and body size on RV anatomy; (3) develop normative equations. Methods and Results-RV volumes (end-diastolic volume and end-systolic volume), stroke volume, and EF were measured by 3D echocardiography in 540 healthy adult volunteers, prospectively enrolled, evenly distributed across age and sex. The relation of age, sex, and body size parameters was investigated using bivariate and multiple linear regression. Analysis was feasible in 507 (94%) subjects (260 women; age, 45±16 years; range, 18-90). Age, sex, height, and weight significantly influenced RV volumes and EF. Sex effect was significant (P<0.01), with RV volumes larger and EF smaller in men than in women. Older age was associated with lower volumes (end-diastolic volume, −5 mLdecade; endsystolic volume, −3 mL/decade; EF, −2 mL/decade) and higher EF (+1% per decade). Inclusion of body size parameters in the statistical models resulted in improved overall explained variance for volumes (end-diastolic volume, R 2 =0.43; end-systolic volume, R 2 =0.35; stroke volume, R 2 =0.30), while EF was unaffected. Ratiometric and allometric indexing for age, sex, and body size resulted in no significant residual correlation between RV measures and height or weight. Conclusions-The MethodsHealthy volunteers were prospectively enrolled in 3 Italian tertiary centers (C1, C2, C3) having a large expertise in 3DE for RV quantification (>400 studies/y per center for both clinical and research purposes). Participating centers were asked to provi...

Despite the post-operative reduction of RV performance along the long axis suggested by TAPSE and PSV, the absence of a decrease in 3D RVEF leads to caution in the interpretation of these 2D and Doppler parameters after cardiac surgery, supporting the hypothesis of geometrical rather than functional changes in the right ventricle.

Pericardial effusion after cardiac surgery is common and its size and site are related to the type of surgery. Cardiac tamponade is rare and is more common in patients receiving oral anticoagulants. Echo-Doppler imaging is useful for the evaluation of pericardial fluid accumulations after cardiac surgery. It can identify effusions that herald cardiac tamponade.

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Three-dimensional TTE and TEE are feasible and useful methods in identifying the location of MV prolapse. They were superior in the description of pathology in comparison with the corresponding 2D techniques and should be regarded as an important adjunct to standard 2D examinations in decisions regarding MV repair.

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PPM may be observed after TAVI and when present may be accompanied by less favorable changes in transvalvular hemodynamics, limited LV mass regression, persistent elevated LV filling pressure, and less improvement in clinical functional status.