5/12/13

A simple way to assess RV function (Accurate too ! ) | Dr.S.Venkatesan MD

Dr.S.Venkatesan MD
Expressions in cardiology
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A simple way to assess RV function (Accurate too ! )

August 10, 2010 by drsvenkatesan Throughout the history of echocardiography Right ventricular functional assessment has received less attention and suffered a step motherly concern. There are innumerable parameters to assess LV function , but we have very few for RV ! LV ejection fraction continue to reign supreme in spite of the inaccuracies and fallacies.RV ejection fraction by echo , never got into the main stream cardiology literature as a tool for RV function assessment. (The major reason for this is , lack of a mathematical shape for RV !) RV is formed by , a horizontal inflow , an elongated and wedged apex ,( in)conspicuous body and an ubiquitous RV outflow .No one really knows , how much these parts contribute individually to the conductive and contractile function of the low pressure venous ventricle. (Of course, MRI and radionuclide derived RV EF can be accurate but doing these tests solely to measure RV EF defies clinical sense !) In this scenario, Two parameter can be considered simple and accurate to estimate the RV function. Tricuspid annular displacement (TAD)

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5/12/13

A simple way to assess RV function (Accurate too ! ) | Dr.S.Venkatesan MD

(http://drsvenkatesan.files.wordpress.com/2010/08/tricuspid-annular-displacement-m-mode-oftricuspid-valve-rv-dysfunction.jpg) (http://drsvenkatesan.files.wordpress.com/2010/08/tricuspid-annular-motion-rv-functionassesment.ppt) This is a simple m-mode derived parameter ( much ridiculed by modern day echo-cardiographer !) M-mode echo in apical 4 chamber view across lateral tricuspid annulus . Normal displacement >2 cm RV dysfunction < 1.5cm Borderline RVD between 1.5 to 1.75 cm The other parameter to measure tricuspid motion is Tricuspid Annulus peak Systolic velocity (TAPSV)* This , in-fact linearly correlate with TAD. Normal TAPSV is > 10cm/sec Anything less than 8cm/sec is usually associated with RV dysfunction. TAPSV http://onlinelibrary.wiley.com/doi/10.1111/j.1540-8175.2006.00305.x/abstract (http://onlinelibrary.wiley.com/doi/10.1111/j.1540-8175.2006.00305.x/abstract) * One need not be depressed if tissue Doppler is not availablein their echo machine , TVD by M mode is good enough in most situations. Situations where RV function is impaired include
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5/12/13

A simple way to assess RV function (Accurate too ! ) | Dr.S.Venkatesan MD

Severe forms of dilated cardiomyopathy. Primary (or secondary ) pulmonary hypertension RV infarction COPD -terminal stages ARVD RV dysfunction with VVI pacing Following CRT Final message It is often said there will always be a simple solution for any complex problem . But, it is recognised late. In our quest for ideal RV functional parameter , we were entangled in the complexities for decades , only to realise an obscure M -mode parameter in apical 4 chamber , could be an accurate way to exclude significant RV dysfunction. Posted in echocardiography, Uncategorized | Tagged About m mode theseof ads tricuspid (http://en.wordpress.com/aboutvalve, rv dysfunction, rv ef, rv function assessment, tad 2cm, tdi of tricuspid annulus, these-ads/) tricuspid annular displacement, tricuspid annular motion, tricuspid annular peak velocity | Leave a Comment Comments RSS

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