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Three-Dimensional Echocardiography for Evaluation of the Right Ventricle—Updates on Image Acquisition and Analysis

  • Echocardiography (F Asch and S Costa, Section Editors)
  • Published:
Current Cardiovascular Imaging Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Review three-dimensional echocardiographic (3DE) acquisition and analysis of the right ventricular (RV) chamber, the recommended technique by the American Society of Echocardiography guidelines.

Recent Findings

3DE acquisition and analysis of RV size and function is available in the majority of clinical echocardiographic laboratories. Recent publications showed this approach provides accurate information despite the challenging chamber anatomy and physiology, when compared to magnetic resonance imaging as reference. 3DE assessment directly measures RV volumes without geometric assumptions. Accordingly, 3DE analysis was found more accurate and reproducible than conventional 2DE methodology, which measures only surrogate parameters of RV function.

Summary

RV 3DE assessment is ready for routine clinical use and has direct implications for patient management. 3DE evaluation has the potential to expand the analysis not only to traditionally parameters of size and function, but to new indices including shape, which may become a new useful diagnostic and prognostic information.

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Author information

Authors and Affiliations

  1. MedStar Health Research Institute, Washington Hospital Center, 110 Irving St., NW, EB-5123, Washington, DC, 20010, USA

    Diego Medvedofsky

  2. Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA

    Eric Kruse, Victor Mor-Avi & Roberto M. Lang

Authors
  1. Diego Medvedofsky
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Correspondence to Diego Medvedofsky.

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There are no issues related to this article that could be construed as a violation of ethical standards.

Conflict of Interest

Eric Kruse reports personal fees from Lantheus Medical Imaging outside of the submitted work. Roberto Lang reports grants from Philips and TOMTEC, outside of the submitted work. The other authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Echocardiography

Electronic Supplementary Material

2DE RV focused 4-chamber view. From a 2DE apical conventional 4-chamber view, the RV focused 4-chamber view is obtained by modifying the position of the transducer more laterally, and its angle more anterior. (MP4 2917 kb)

Video 2

Right ventricular (RV)-focused 3DE dataset acquisition with simultaneous real-time short-axis and long-axis multiplanar reconstruction. An effort should be done to include the entire RV free wall for a more accurate analysis. (WMV 1272 kb)

Top: an example of a good quality 3D RV dataset without contrast (left), in which endocardial border definition further improved with contrast enhancement (right). Bottom: an example of a suboptimal quality 3D RV dataset, in which the endocardial border is poorly visualized without contrast (left), but was considerably improved by contrast enhancement (right), specially for the RV free wall anterior and lateral segments. (MP4 2208 kb)

Video 4

Combined video (left), end-diastolic (center) and end-systolic (right) views, in short-and long-axis views of the right ventricle used to fine tune endocardial border detection. The long-axis image plane can be changed (dotted yellow line in the short-axis views) to assess correct tracing along the right ventricular surface. (WMV 4811 kb)

Two right ventricular generated beating models with a fixed end-diastolic mesh, without (left) and with (right) a 2-dimensional background. (MP4 1360 kb)

Video 6

Similar endocardial border analyses as explained in Video 4, but with contrast enhancement. Imaging of the right ventricle is feasible and results in visible improvement in the definition of the free wall segments in patients with suboptimal visualization without contrast. One difference is that with contrast, the RVOT is considerably better visualized. (WMV 4269 kb)

Video 7

3D fully automatic, dynamic volumetric analysis is one of the next steps for 3D RV analysis. (MOV 625 kb)

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Medvedofsky, D., Kruse, E., Mor-Avi, V. et al. Three-Dimensional Echocardiography for Evaluation of the Right Ventricle—Updates on Image Acquisition and Analysis. Curr Cardiovasc Imaging Rep 11, 18 (2018). https://doi.org/10.1007/s12410-018-9460-6

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