Right Ventricle Steven J. Lester MD, FACC, FRCP(C), FASE Mayo Clinic, Arizona
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1 Right Ventricle Steven J. Lester MD, FACC, FRCP(C), FASE Mayo Clinic, Arizona 1. In which scenario will applying the simplified Bernoulli equation to the peak tricuspid regurgitation velocity and adding an estimate of right atrial pressure likely not result in an under estimation the right ventricular systolic pressure. a. When there is pulmonary valve stenosis. b. When there is severe tricuspid regurgitation c. When there is marked dilation of the right ventricle d. When you are unable to align the continuous wave Doppler signal parallel to the intercept angle of the axis of flow. 1
2 Assumptions 1. Velocity is only dependent on pressure. (fr-fo) = 2fo v (cosθ) / c Doppler Frequency Shift Equation If V1 is significant ( >1.5 m/sec) Presence of anemia (viscous friction) Assumptions 1.Velocity is only dependent on pressure. Flow = Area x Velocity Heart Rate Contractility 2
3 Velocity = Flow Area Assumptions 1.Velocity is only dependent on pressure. 2.You can accurately estimate right atrial pressure. - Non simultaneous - Peak systole 3
4 Systolic RV RA pressure equalization R V RA 4
5 Assumptions 1.Velocity is only dependent on pressure. 2.You can accurately estimate right atrial pressure. 3.Right ventricular systolic pressure = Pulmonary artery systolic pressure TRV = 4.8 m/sec 1 = 2.64 cm 2 = 1.96 cm RVSP = 4 X TR vmax2 + estimated RA pressure = 4 (4.8) = 105 mmhg 1 2 5
6 RV-PA Gradient = 36 mmhg 3 SPAP = RVSP PV gradient = = 69 mmhg 2. Women have smaller right ventricular end-diastolic volumes when compared to men. Also older age is associated with smaller volumes. Therefore, you would expect the right ventricular ejection fraction (RVEF) of older women compared to younger men to be? a) The RVEF would be the same in both the older women and younger men. b) The RVEF would be higher in older women compared to younger men c) The RVEF would be lower in older women compared to younger men. 6
7 3. A 47 year old women has a dilated right ventricle with reduced right ventricular function along with signs and symptoms of right heart failure. The calculated right ventricular index of myocardial performance (RIMP) determined by pulsed wave Doppler was She was treated with diuretics and clinically improved as her right atrial pressure decreased. You now recalculate the RIMP and you would expect the value to? a. Higher than prior to treatment with diuretics b. Lower than prior to treatment with diuretics c. Unchanged arterial ventricular atrial 7
8 Effect of decrease in LA pressure Lasix 80 mg Ac Mo Ao 215 Tei index = = Tei index = = Courtesy Dr. Hatle 4. With respect to the S velocity, an example shown below, the following statement is true. S = 0.14 m/s a. The S velocity obtained by pulsed wave tissue Doppler will be lower than the S velocity if obtained by color tissue Doppler. b. The S velocity represents global right ventricular function. c. S velocity will be reduced following open heart surgery. d. The value of S is not angle dependent. 8
9 5. 3D methods with which to calculate right ventricular (RV) volumes and ejection fraction may be superior to 2D methods for the following reason. a. 3D methods of calculating RV volumes and ejection fraction are less load dependent than 2D methods. b. 3D methods of calculating RV volumes and ejection fraction are less dependent on image quality then 2D methods. c. 3D but not 2D methods with which to calculate RV volumes and ejection fraction correlate with values obtained by MRI. d. 3D methods include the RV outflow tract contribution to overall function while 2D methods do not. 9
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