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Is an echo the best rightheart catheter?
PD Dr med. Bernhard Herzog
No disclosures
Can echo answer myquestion?
Right Heart Disease
Tricuspid valve disease
Right Ventriular Infarction
Pulmonary Hypertension
Pulmonary valve disease
ARVC
Shunts
Right Heart Disease
Size & Function- Right Ventricle- Left Ventricle
Size- Atria- MPA / PAs- Inferior Vena Cava
Morphology & Function- Tricuspid Valve- Pulmonary Valve- Mitral Valve- Aortic Valve
Pulmonary Pressure
Tricuspid valve disease
Right Ventriular Infarction
Pulmonary Hypertension
Pulmonary valve disease
ARVC / Sarcoidosis
Shunts
Right Ventricular Size
RV linear dimensions
- inflow
RV linear dimensions
- outflow
RV end-diastolic area
RV 3D volume
J Am Soc Echocardiogr 2015;28:1-39
RV modified / focusedapical 4CH
J Am Soc Echocardiogr 2010;23:685-713
Right Ventricular Size - Limitations- Image Quality-
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Right Ventricular Size - Limitations- Image Plane-
J Am Soc Echocardiogr 2015;28:1-39
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Right Ventricular Size - Limitations
• Image Quality
• Image Plane
• Trabeculations
X
Right Ventricular Size - Limitations
• Image Quality
• Image Plane
• Trabeculations
• Normal Values
Right Ventricular Function
FAC
3D function
RV longitudinal functionTAPSE
Color tissue Doppler
S wave
Pulsed tissue Doppler
S wave
Global longitudinal strain
J Am Soc Echocardiogr 2015;28:1-39
RIMP PW
RIMP TDI
Right Ventricular Function- Limitations
• Image Quality
• Image Plane
• Trabeculations
• Normal Values
• Alignment
Atria
J Am Soc Echocardiogr 2015;28:1-39
LA RA
MPA / PAs & IVC
Pulmonary Hypertension
Pulmonary Hypertension
Pulmonary Hypertension - Limitations
• Image Quality
• Image Plane
• Trabeculations
• Normal Values
• Alignment
• Severity of tricuspid regurgitation
• Right ventricular function
• Inspiration (higher with inspiration)
• Echo is the first line modality
• Echo is not a right heart catheter
• RV assessment is challenging – NOT only for echo
• Get as many pieces of the puzzle as possible
• Take other imaging modalities if necessary
Take Home Message
