SUMMARY No data are available on determining right atrial and right ventricular size by two-dimensional echocardiography. We performed two-dimensional echocardiograms on eight human right-heart casts obtained at autopsy and on 50 patients who underwent complete left-and right-heart catheterization. Measurement of individual dimensions of the long and short axes of the right atrium and ventricle from right heart casts closely correlated with the volume of these structures as determined by water displacement. Further, individual dimensions by cross-sectional echo correlated well with actual casts dimensions. Subsequently, echocardiographic measurements of right atrial and ventricular long and short axes were obtained in the apical fourchambered view in a group of normals and compared with a group of patients with right ventricular volume overload states. Mean values for right atrial short-axis and long-axis measurements were greater in right ventricular volume overload patients than in normals: 6.5 ± 0.3 vs 3.6 ± 0.1 cm, and 6.0 ± 0.3 vs 4.2 ± 0.1 cm, respectively (both p < 0.001). In addition, measurements of both individual dimensions as well as planed area of the right ventricle were greater in right ventricular volume overload patients than in normals: maximal short axis 6.1 ± 0.3 vs 3.5 ± 0.2 cm, mid-short axis 6.1 ± 0.4 vs 2.8 ± 0.2 cm, and area 40 ± 2.6 vs 18 ± 1.2 cm' (all p < 0.001). There were no differences in right ventricular long-axis measurement. Two-dimensional echocardiography provided better separation of normals from right ventricular volume overload patients than did M-mode techniques. Thus, two-dimensional echocardiography, with the apical four-chambered view, enables accurate visualization of the right atrium and ventricle in almost all patients. Further, measurements of right atrial and right ventricular size by two-dimensional echocardiography readily distinguish normal patients from those with right ventricular volume overload.M-MODE ECHOCARDIOGRAPHY has dramatically altered cardiac diagnostics by providing a noninvasive method of documenting the presence of a variety of cardiac disorders, including valvular heart disease,1 2 cardiac myxomas,3 and pericardial effusion.4 This technique also permits accurate atraumatic determination of left atrial and left ventricular dimensions.5 " One area in which M-mode echocardiography has not been important, however, is in evaluating the right-sided cardiac chambers. Because of an inaccessible intrathoracic position and an irregular geometrical shape, the right atrium and right ventricle are difficult structures from which to obtain reproducible echographic signals by M-mode examination.Recently, two-dimensional echocardiographic methods have been developed which can provide a 30-80°sector arc image of cardiovascular structures.7`9 The spatial orientation afforded by such techniques has enabled cardiac imaging from new thoracic windows. Thus, with the ultrasound transducer positioned at the cardiac apex and directed toward the right shoulder, a simulta...

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