Echocardiography Imaging of the Right Ventricle: Focus on Three-Dimensional Echocardiography

Figures

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  Figure 1. Schematic illustration of the right ventricular components (1., 2., 3.) from anterior (panel (A)) and septal (panel (B)) perspectives. The inlet part (1.) constitutes the tricuspid valve apparatus, the trabecular part (2.) involves the apex with the three intracavitary muscle bands, and the outlet part (3.) includes the subpulmonary infundibulum (*). The contraction of the right ventricle starts earlier within the inlet and trabeculated myocardium than the outlet myocardium.

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  Figure 2. Two-dimensional transthoracic echocardiography images in a case of severe functional tricuspid regurgitation with enlarged atria (A,B). Panels (C–E) show normal two-dimensional longitudinal indices of right ventricular function, such as tricuspid annular planar systolic excursion (TAPSE), right ventricular free wall longitudinal strain (RVFWSL), right ventricular 4-chamber longitudinal strain (RV4CSL), right ventricular tissue doppler imaging-derived systolic (S) wave velocity (RV S vel). RA: right atrium; RV: right ventricle.

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  Figure 3. Representative three-dimensional transthoracic echocardiography evaluation of right ventricular function (panel (A)) showing mildly diminished right ventricular function in the same patient in Figure 1. Panel (B) demonstrates the three-direction motion components of right ventricular function. RV EF: right ventricular ejection fraction; RVEDVi: indexed right ventricular end-diastolic volume; RVESVi: indexed right ventricular end-systolic volume; RV SV: right ventricular stroke volume; TV: tricuspid valve; PV: pulmonic valve; Long: longitudinal; SAX: short axis; 4Ch: four chamber.

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  Figure 4. Representative three-dimensional transthoracic echocardiography analysis showing severe functional tricuspid regurgitation with significant coaptation gap (red arrow) in the same patient of Figure 1 and Figure 2. The three-dimensional data set of the tricuspid valve is analyzed with multiplanar reformation planes that display the valve in three orthogonal planes: green (panel A), red (panel B) and blue (panel C) planes). The green (panel A) and red (panel B) planes cross the tricuspid valve longitudinally. The blue plane (panel C) crosses the tricuspid valve at the level of the leaflets coaptation and shows the short-axis of the valve from right ventricular perspective. (Panel D) demonstrates the three leaflets of the tricuspid valve in a surgical view (from atrial perspective): septal leaflet (S); anterior leaflet (A); and posterior leaflet (P). RA: right atrium, RV: right ventricle.

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  Figure 5. Representative two-dimensional mid-esophageal ((A–C) panels) and three-dimensional transgastric (D) panel) echocardiography images showing severe tricuspid regurgitation and prolapsing tricuspid valve (red arrow). (Panel D) demonstrates a three-dimensional multiplanar reconstruction of the tricuspid valve acquired from transgastric right ventricular long-axis view and three-dimensional vena contracta area (A1) measurement. LA: left atrium; RA: right atrium; RV: right ventricle; Ao: aortic valve; S: septal leaflet; A: anterior leaflet; P: posterior leaflet.

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  Figure 6. Two-dimensional mid-to-deep esophageal (panels (A,C)), three-dimensional mid-to-deep esophageal (panel (B)), and three-dimensional transgastric echocardiography images demonstrating the added value of three-dimensional echocardiography after pacemaker lead extraction due to infection. Two-dimensional echocardiography shows one mobile mass on the posterior leaflet of the tricuspid valve (panel (A), red arrow) and moderate tricuspid regurgitation (panel (C)); however, three-dimensional echocardiography revealed a further mass (panel (B), blue arrow) on the right atrial wall adjacent to the sinus of Valsalva. Notably, the transgastric three-dimensional view (panel (D)) showed only the mass attached to the posterior leaflet (red arrow). RV: right ventricle, LV: left ventricle, Ao: aortic valve, A: anterior leaflet, P: posterior leaflet, S: septal leaflet.