This echocardiogram shows a markedly dilated and hypertrophied right ventricle. The left ventricle, interventricular septum, posterior wall and mitral valve are well seen. In the real-time study that follows, note the small size of the left ventricle and normal posterior wall motion. The mitral valve is normal in motion and morphology. There is no evidence of rheumatic valvular heart disease. Note also the poor contractility of the large right ventricle and that the flattened interventricular septum moves towards the right ventricle during systole, a finding consistent with pulmonary hypertension.
RV enlargement - short axis view
This is a systolic still-frame in the parasternal short axis view in our patient at the level of the ventricles. Note again the markedly enlarged right ventricle. The septum is bowed outward toward the right ventricle. In the real-time study that follows, note that the septum, which normally moves towards the posterior wall of the left ventricle in systole, moves anteriorly towards the right ventricle, or paradoxically. The left ventricular cavity size reflects the cardiac output and both become reduced as the pulmonary vascular resistance increases. Portions of the tricuspid valve apparatus are seen within the dilated right ventricle.
Moderate pulmonary regurgitation - color flow
This is a diastolic still-frame of a color flow Doppler from the short axis view at the level of the aorta in our patient, showing a dilated pulmonary artery with moderate pulmonary regurgitation, as evidenced by the orange color jet in the right ventricle. In the real-time study that follows, note the orange color jet moving retrograde from the level of the pulmonic valve into the right ventricle, consistent with moderate pulmonary regurgitation. The left and right pulmonary arteries are easily identified.
Bubble study - modified apical 4-chamber view
This is a systolic still-frame of a two-dimensional echocardiogram in a modified apical 4-chamber view in our patient. It was obtained just prior to injecting agitated saline into a peripheral vein. The right atrium, right ventricle, tricuspid valve, left atrium and left ventricle are seen. In the real-time study that follows, note the bubbles produced by the saline infusion entering the right atrium, crossing the tricuspid valve and appearing in the right ventricle. No right-to-left shunt is noted, as no bubbles cross over to the left atrium.
Determination of pulmonary artery systolic pressure
Pulmonary artery systolic pressure may be determined echocardiographically, as in our patient. Mild tricuspid regurgitation, not evident on the physical examination, was evident on the echocardiographic strudy. Though not shown, the peak instantaneous systolic gradient between the right ventricle and right atrium, measured using the regurgitant jet was 77 mmHg. The right atrial pressure was estimated to be 15 mmHg. The right ventricular systolic pressure can be calculated by adding the above gradient to the estimated right atrial pressure, resulting in a calculated pressure of 92 mmHg. Pulmonary artery systolic pressure will be identical to this right ventricular sytolic pressure, given no obstruction at the pulmonary outflow tract.