2D Views of the Right Ventricle

Right Ventricle OutlineAnatomy of the Right Ventricle2D Views of the Right VentricleRight Ventricular Systolic FunctionDoppler Evaluation of the Right VentricleRight Ventricular DilationRight Ventricular HypertrophySummaryCME and Self Assessment Exams

Since the right ventricle is irregular, multiple views are required to assess the right ventricular anatomy and function. The standard views are the midesophageal 4 chamber view, the right ventricular inflow-outflow view, the transgastric short axis view, and the transgastric right ventricular inflow view. Non-standard views include the transgastric right ventricular outflow view, upper esophageal pulmonary valve long axis view, and deep transgastric right ventricular long axis view.

Midesophageal 4 Chamber View (4CV)

The midesophageal 4 chamber view is the best view of the right ventricle. Right ventricular size, global systolic function, right ventricular free wall function, right ventricular apical displacement and interventricular septal displacement, right and left ventricular size, tricuspid valve competence and right atrial size, can all be assessed in a single view. The right ventricle appears as a triangle or pyramid attached to the left ventricle. The right ventricle is 1/3 the size of the left ventricle, has a free wall that is less than 1 cm thick, appears triangular, and the right ventricular apex extends to 2/3 of the left ventricular aoex. The apex of the heart is formed from the left ventricle, not the right ventricle.

Normals
RV Area = 0.6 x LV Area
RV Length = 0.6 LV Length
RVApex < LV Apex
RVWt = LVWT / 2
RVWt < 5 mm (end-diastolic)
Wt = Wall Thickness
Table 6.2.1

Midesophageal Right Ventricular Inflow-Outflow View (RVIO)

The midesophageal right ventricular-inflow-outflow (RVIO) view is found at the midesophageal acoustic window and either in the same viewing plane as the short axis of the aortic valve or just slightly distal (deeper). The RVIO view or "wrap-around" view, provides a single view of the right atrium, right ventricle, tricuspid valve, pulmonary valve, and pulmonary artery. The right atrium-right ventricle-pulmonary artery appear to wrap around the aortic valve and left atrium. The entire right ventricle free wall which is perpendicular to the ultrasound beam, can be assessed for wall motion along its entire length. The RVIO view provides a view to assess the right ventricular function and perform doppler studies of the tricuspid valve for right ventricular systolic pressure calculation and assess the competence of the tricuspid and pulmonary valves.

Transgastric Right Ventricular Short Axis View (RV SAX)

The right ventricular short axis view (RVSAX) can be obtained by finding the mid transgastric left ventricular short axis view and turning the probe to the right or clockwise. The right ventricle appears as a crescent shaped structure attached to the left ventricle. Assessment of right ventricular function and the interventricular septal function or wall motion is possible in this view. The right ventricular muscle bands and papillary muscles may be present.