Determination of right atrial and right ventricular size by two-dimensional echocardiography.

Abstract

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...

Tricuspid Valve Tethering Predicts Residual Tricuspid Regurgitation After Tricuspid Annuloplasty

“…Then RV fractional area change was calculated: end-diastolic area minus end-systolic area divided by end-diastolic area times 100. 12,13 Second, minimal TV annulus diameter was measured in the apical 4-chamber view as the distance between the points of reflection of the septal and mural endocardium on the anterior and septal tricuspid leaflets, respectively. The distance and area of TV tethering were measured by tracing between the atrial surface of the leaflets and the tricuspid annular plane at the time of maximal systolic closure (Figure 1).…”

“…In addition, assessment of RV function through the use of fractional area change may not be accurate enough to determine RV volume and function. 12,13 Moreover, RV size and geometry are technically difficult to determine accurately with 2D echocardiography because of its anatomic complexity. Changes of ventricular geometry may cause the tethering of TV leaflet through the displacement of the papillary muscles, determining the outcome of tricuspid annuloplasty.…”

Right atrial function in hypertensive patients: effects of antihypertensive therapy

“…The area was chosen in this study because it has been used in patients with variable RA and RV size. 11 Doppler flow velocity measurements were performed from a position providing the highest overall velocities, implying the least angulation with flow. Averaging consecutive cardiac cycles and measuring during end-expiration apnea has counterbalanced the effect of respiration on right-side flow.…”

“…[7][8][9][10] Noninvasive RA function has been performed with echocardiography by means of RA volume measurements. [11][12][13] Indirectly, RA function can also be evaluated with the use of pulsed Doppler echocardiography by means of trans-tricuspid flow velocity measurements in a similar manner with that used for the estimation of left atrial function. 14,15 Two of the most commonly used groups of antihypertensive drugs in patients with essential hypertension are angiotensin-converting enzyme inhibitors and calcium-channel antagonists.…”

Two-dimensional echocardiographic assessment of electrocardiographic criteria for right atrial enlargement.

“…However, measurements obtained from two-dimensional echocardiography have been found to correlate well with the actual volume of the right atrium. 10 We conclude that the QRS pattern in lead V1 may be extremely accurate in detecting right atrial enlargements. Other electrocardiographic signs are much less useful in detecting right atrial enlargement, particularly those patterns that rely on an increase in Pwave voltage.…”