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SUMMARY We studied the inferior vena cava (IVC) as an index of right-heart function in 111 patients. A two-dimensional echocardiographic sector was used to visualize the IVC, and its M-mode cursor was used to generate a time-motion record of the IVC size and pulsation. Normal subjects had a small presystolic A wave (less than 125% of the end-diastolic IVC dimension), a small systolic V wave (less than 140% of the enddiastolic IVC dimension), and a 50% inspiratory decrease in IVC dimension. GRAY-SCALE B-SCAN ULTRASONOGRAPHY is useful for diagnosing masses invading or compressing the inferior vena cava (IVC).'-8 Furthermore, realtime two-dimensional echocardiographic detection of IVC microcavitations after peripheral contrast injection is valuable for diagnosing tricuspid insufficiency.9Ill The purpose of this report is to describe the normal and abnormal time-motion echocardiographic characteristics of IVC size and pulsation and to identify the physiologic and pathophysiologic determinants of the IVC echogram. Materials and MethodsThe time-motion IVC ultrasonographic data in 1 1 1 patients who also had hemodynamic, contrast right ventricular angiographic, radionuclide right ventricular angiographic or pathologic study form the basis of this report. Ten patients were normal. Sixty-seven patients had mitral stenosis, mitral insufficiency or mitral valve prosthesis. Nine patients had an atrial septal defect. One patient had a patent ductus arteriosus, one anomalous pulmonary venous drainage, one primary tricuspid insufficiency, five patients had coronary artery disease, 13 hypertrophic or congestive cardiomyopathy, three constrictive pericarditis, and one patient had recurrent pulmonary emboli with pulmonary hypertension. Eighteen of these patients required maintenance hemodialysis for chronic renal failure. IVC echographic studies were performed using a Varian V-3000 or V-3400 phased-array ultrasonoscope. The transducer was placed in a subxiphoid or right subcostal position and rotated so that the twodimensional sector was parallel to the IVC. In this manner, the course of the IVC behind the liver, extending through the diaphragm, and anastomosing with the right atrium12 was imaged ( fig. 1). The transducer was rocked slightly medially and laterally to record the maximum IVC size. The M-mode cursor of the two-dimensional sector was used to generate a time-motion recording of the IVC. The cursor was positioned inferior to the junction of the hepatic veins with the IVC. Care was taken not to measure the IVC where it dilates at the junction of the right atrium. A time-motion study of the IVC was recorded through several respiratory cycles. All measurements were normalized for body surface area and a mean of two respiratory cycles during normal quiet breathing was calculated. The end-diastolic IVC dimension was measured as the minimum IVC size at or after the R wave of the ECG; this was usually, but not always, the smallest IVC diameter during the entire cardiac cycle. A presystolic (A wave) pulsation was recorded in p...

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