New Directions in Right Ventricular Assessment Using 3-Dimensional Echocardiography

Abstract

Two-dimensional echocardiographic evaluation of RV size and function includes measures of systolic basal longitudinal excursion (tricuspid annular plane systolic excursion and peak systolic velocity), fractional area change, and free-wall strain, all of which are measured from a single tomographic imaging plane: the RV-focused view. Given this limitation, clinical situations in which more accurate assessment of the RV or close patient follow-up were required were resolved with the use of cardiovascular magnetic resonance, computed tomography, and other modalities to obtain global measures of size and function (ie, volume and ejection fraction). With 3-dimensional echocardiography, both volume and ejection fraction assessments of the RV are possible with an accuracy and reproducibility close to that of cardiovascular magnetic resonance imaging. Further, 3-dimensional RV data sets can be cropped, sliced, and rotated to assess device leads, tricuspid valve leaflets, and RV wall-motion abnormalities. The 3-dimensional RV data set opens the horizon to endless possibilities for further exploration of novel parameters, including 3-dimensional RV shape and 3-dimensional RV deformation analysis. CONCLUSIONS AND RELEVANCEThe use of 3-dimensional echocardiography overcomes many of the limitations associated with conventional 2-dimensional echocardiography and has the potential to provide the detailed information required for the complex clinical decision-making that requires accurate, quantitative information about the RV.

Importance of Nonlongitudinal Motion Components in Right Ventricular Function: Three-Dimensional Echocardiographic Study in Healthy Volunteers

“…16 Three main mechanisms generate RV ejection: shortening along the longitudinal axis with the traction of the tricuspid annulus toward the apex (longitudinal motion), inward movement of the RV free wall (radial motion), and traction of the RV free wall insertion points by the circumferential deformation of LV myocardium (anteroposterior motion). 19 These motion components correspond to the myocardial architecture of the right ventricle. The RV myocardium consists of a complex 3D architecture of myofibers in which two main layers are present: a predominantly longitudinally aligned subendocardial layer and a dominantly circumferentially oriented subepicardial layer.…”

Regional shape, global function and mechanics in right ventricular volume and pressure overload conditions: a three-dimensional echocardiography study

“…Part of this lack of knowledge was related to the complex three-dimensional anatomy of the RV [7], its peculiar contraction pattern [8], and the difficulty to obtain a comprehensive imaging of the RV by two-dimensional echocardiography (2DE) [9]. Recent advancements in three-dimensional transthoracic echocardiography (3DE) allow to encompass the entire RV in a single pyramidal dataset and to perform a detailed quantitative analysis of its size, shape and function [10].…”

Atrial functional tricuspid regurgitation: a novel and underappreciated clinical entity

“…In advanced stages, RV dilatation is present, mainly due to chronic volume overload 22 . Qualitative parameters consist of in- ating atrial FTR from ventricular FTR [38][39][40] . 3DE allows the simultaneous visualization of all three valve leafl ets to reliably exclude any structural abnormalities and the quantitative automated analysis of all components of the TV apparatus accounting for their complex three-dimensional shape.…”