The Right Atrium

  • Diletta Peluso
  • Marcelo Haertel Miglioranza


Right atrium (RA) has been a neglected heart chamber for long time. Only recently, the recognition of its role in assisting right ventricular filling, the demonstration of the predictive value of RA size in various pathological conditions, and the identification of the RA as a target and transit chamber for many interventional procedures have raised clinical interest in RA assessment. Accordingly, three-dimensional echocardiography (3DE) has acquired an important role in RA evaluation. It allows to visualize internal structures of the RA with a richness of details that is comparable with the anatomical specimens. This capability is used more and more in the electrophysiology and catheterization laboratories and moreover it demonstrated to be useful in differentiating normal from pathological anatomical structures.

Recently, the updated guidelines on cardiac chamber quantification by echocardiography have introduced the RA volume as the recommended parameter to report RA size. 3DE demonstrated its capability to accurately measure RA volume, indipendently from any geometrical assumption about its shape, overcoming the limitations of two-dimensional echocardiography. Furthermore, 3DE enables measurement of RA volume in different moments of the cardiac cycle (maximum, minimum and pre-atrial contraction volumes), allowing evaluation of RA phasic function, in term of emptying volumes and fractions.


Right atrium Three-dimensional echocardiography Right atrial volume Right atrial function Right atrial structures Right atrial shape 


  1. 1.
    Harvey W. An anatomical study of the movement of the heart and blood in animals (translated by Leake CD, 1628). Baltimore: Thomas; 1928, p. 123.Google Scholar
  2. 2.
    Carlson DE, Burchard KW, Gann DS. Right atrial volume during hemorrhage in the dog. Am J Physiol Heart Circ Physiol. 1986;250(6 Pt 2):H1136–44.CrossRefGoogle Scholar
  3. 3.
    Ferguson JJ III, Miller MJ, Aroesty JM, Sahagian P, Grossman W, McKay RG. Assessment of right atrial pressure-volume relations in patients with and without an atrial septal defect. J Am Coll Cardiol. 1989;13(3):630–6.CrossRefGoogle Scholar
  4. 4.
    Maniar HS, Prasad SM, Gaynor SL, Chu CM, Steendijk P, Moon MR. Impact of pericardial restraint on right atrial mechanics during acute right ventricular pressure load. Am J Physiol Heart Circ Physiol. 2003;284(1):H350–7.CrossRefGoogle Scholar
  5. 5.
    Miller MJ, McKay RG, Ferguson JJ, Sahagian P, Nakao S, Come PC, Grossman W. Right atrial pressure-volume relationships in tricuspid regurgitation. Circulation. 1986;73(4):799–808.CrossRefGoogle Scholar
  6. 6.
    Gaynor SL, Maniar HS, Prasad SM, Steendijk P, Moon MR. Reservoir and conduit function of right atrium: impact on right ventricular filling and cardiac output. Am J Physiol Heart Circ Physiol. 2005;288(5):H2140–5.CrossRefGoogle Scholar
  7. 7.
    Nemes A, Domsik P, Kalapos A, Kormanyos A, Ambrus N, Forster T. Three-dimensional speckle-tracking echocardiography detects different patterns of right atrial dysfunction in selected disorders: a short summary from the MAGYAR-Path Study. Quant Imaging Med Surg. 2018;8(2):182–6.CrossRefGoogle Scholar
  8. 8.
    Moreno J, Perez de Isla L, Campos N, Guinea J, Dominguez-Perez L, Saltijeral A, et al. Right atrial indexed volume in healthy adult population: reference values for two-dimensional and three-dimensional echocardiographic measurements. Echocardiography. 2013;30(6):667–71.CrossRefGoogle Scholar
  9. 9.
    Muller H, Reverdin S, Burri H, Shah D, Lerch R. Measurement of left and right atrial volume in patients undergoing ablation for atrial arrhythmias: comparison of a manual versus semiautomatic algorithm of real time 3D echocardiography. Echocardiography. 2014;31(4):499–507.CrossRefGoogle Scholar
  10. 10.
    Peluso D, Badano LP, Muraru D, Dal Bianco L, Cucchini U, Kocabay G, et al. Right atrial size and function assessed with three-dimensional echocardiography in 200 healthy volunteers. Eur Heart J Cardiovasc Imaging. 2013;14(11):1106–14.CrossRefGoogle Scholar
  11. 11.
    Raymond RJ, Hinderliter AL, Willis PW, Ralph D, Caldwell EJ, Williams WG, et al. Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension. J Am Coll Cardiol. 2002;2002(39):1214–9.CrossRefGoogle Scholar
  12. 12.
    Bustamante-Labarta M, Perrone S, De La Fuente RL, Stutzbach P, De La Hoz RP, Torino A, et al. Right atrial size and tricuspid regurgitation severity predict mortality or transplantation in primary pulmonary hypertension. J Am Soc Echocardiogr. 2002;15:1160–4.CrossRefGoogle Scholar
  13. 13.
    Tadic M. The right atrium, a forgotten cardiac chamber: an updated review of multimodality imaging. J Clin Ultrasound. 2015;43(6):335–45.CrossRefGoogle Scholar
  14. 14.
    Aune E, Baekkevar M, Roislien J, Rodevand O, Otterstad JE. Normal reference ranges for left and right atrial volume indexes and ejection fractions obtained with real-time three-dimensional echocardiography. Eur J Echocardiogr. 2009;10:738–44.CrossRefGoogle Scholar
  15. 15.
    Faletra FF, Muzzarelli S, Dequarti MC, Murzilli R, Bellu R, Ho SY. Imaging-based right-atrial anatomy by computed tomography, magnetic resonance imaging, and three-dimensional transoesophageal echocardiography: correlations with anatomic specimens. Eur Heart J Cardiovasc Imaging. 2013;14(12):1123–31.CrossRefGoogle Scholar
  16. 16.
    Faletra FF, Ho SY, Auricchio A. Anatomy of right atrial structures by real-time 3D transesophageal echocardiography. JACC Cardiovasc Imaging. 2010;3(9):966–75.CrossRefGoogle Scholar
  17. 17.
    Loukas M, Tubbs RS, Tongson JM, Polepalli S, Curry B, Jordan R, Wagner T. The clinical anatomy of the crista terminalis, pectinate muscles and the teniae sagittalis. Ann Anat. 2008;190(1):81–7.CrossRefGoogle Scholar
  18. 18.
    Cabrera JA, Sanchez-Quintana D, Ho SY, Medina A, Anderson RH. The architecture of the atrial musculature between the orifice of the inferior caval vein and the tricuspid valve: the anatomy of the isthmus. J Cardiovasc Electrophysiol. 1998;9(11):1186–95.CrossRefGoogle Scholar
  19. 19.
    Ho SY, Ernst S. The right atrium relevant to supraventricular tachycardia. In: Anatomy for cardiac electrophysiologists. A practical handbook. Cardiotext; 2012. p 97–127.Google Scholar
  20. 20.
    Chiari H. Ueber Netzbildungen im rechten Vorhof des Herzens. Beitr Path Anat. 1897;22:1–10.Google Scholar
  21. 21.
    Lanzarini L, Lucca E, Fontana A, Foresti S. Cor triatriatum dextrum resulting from the persistence of embryonic remnants of the right valve of the sinus venosus: prevalence and echocardiographic aspects in a large consecutive non-selected patient population. Ital Heart J Suppl. 2001;2(11):1209–16.PubMedGoogle Scholar
  22. 22.
    Betrián Blasco P, Sarrat Torres R, Pijuan Domènech MA, Marimón Blanch C, Pérez Herrera V, Girona Comas J. Three-dimensional Imaging of Redundant Chiari’s Network Prolapsing into Right Ventricle. J Am Soc Echocardiogr. 2008;21(2):188.e1–2. Epub 2007 Jul 23.CrossRefGoogle Scholar
  23. 23.
    Iida R, Vonder Muhll I. A prominent eustachian valve dividing the right atrium imaged by three-dimensional transesophageal echocardiography. J Clin Ultrasound. 2013;41(8):514–6.CrossRefGoogle Scholar
  24. 24.
    Kalman JM, Olgin JE, Karch MR, Hamdan M, Lee RJ, Lesh MD. Cristal tachicardias’: origin of right atrial tachicardias from crista terminalis identified by intracardiac echocardiography. J Am Coll Cardiol. 1998;31(2):451–9.CrossRefGoogle Scholar
  25. 25.
    Sato T, Tsujino I, Oyama-Manabe N, Ohira H, Ito YM, Yamada A, et al. Right atrial volume and phasic function in pulmonary hypertension. Int J Cardiol. 2013;168(1):420–6.CrossRefGoogle Scholar
  26. 26.
    Moceri P, Dimopoulos K, Liodakis E, Germanakis I, Kempny A, Diller GP, et al. Echocardiographic predictors of outcome in Eisenmenger syndrome. Circulation. 2012;126(12):1461–8.CrossRefGoogle Scholar
  27. 27.
    Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2016;37:67–119.CrossRefGoogle Scholar
  28. 28.
    Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233–70.CrossRefGoogle Scholar
  29. 29.
    Chaplygina EV, Kornienko NA, Kaplunova OA, Kornienko AA. Peculiarities of the anatomical structure of the posterior-lower part of the right atrium in people of various constitutional types. Morfologiia. 2013;144(6):32–5.PubMedGoogle Scholar
  30. 30.
    Grapsa J, Gibbs JS, Cabrita IZ, Watson GF, Pavlopoulos H, Dawson D, et al. The association of clinical outcome with right atrial and ventricular remodeling in patients with pulmonary arterial hypertension: study with real-time three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging. 2012;13(8):666–72.CrossRefGoogle Scholar
  31. 31.
    Quraini D, Pandian NG, Patel AR. Three-dimensional echocardiographic analysis of right atrial volume in normal and abnormal hearts: comparison of biplane and multiplane methods. Echocardiography. 2012;29(5):608–13.CrossRefGoogle Scholar
  32. 32.
    Sallach JA, Tang WH, Borowski AG, Tong W, Porter T, Martin MG, et al. Right atrial volume index in chronic systolic heart failure and prognosis. JACC Cardiovasc Imaging. 2009;2(5):527–34.CrossRefGoogle Scholar
  33. 33.
    Kleijn SA, Aly MF, Terwee CB, van Rossum AC, Kamp O. Comparison between direct volumetric and speckle tracking methodologies for left ventricular and left atrial chamber quantification by three-dimensional echocardiography. Am J Cardiol. 2011;108(7):1038–44.CrossRefGoogle Scholar
  34. 34.
    Keller AM, Gopal AS, King DL. Left and right atrial volume by freehand three dimensional echocardiography: in vivo validation using magnetic resonance imaging. Eur J Echocardiogr. 2000;1(1):55–65.CrossRefGoogle Scholar
  35. 35.
    Badano LP, Boccalini F, Muraru D, Dal Bianco L, Peluso D, Bellu R, et al. Current clinical applications of transthoracic three-dimensional echocardiography. J Cardiovasc Ultrasound. 2012;20(1):1–22.CrossRefGoogle Scholar
  36. 36.
    Mor-Avi V, Yodwut C, Jenkins C, Kühl H, Nesser HJ, Marwick TH, et al. Real-time 3D echocardiographic quantification of left atrial volume: multicenter study for validation with CMR. JACC Cardiovasc Imaging. 2012;5(8):769–77.CrossRefGoogle Scholar
  37. 37.
    Takahashi A, Funabashi N, Kataoka A, Yajima R, Takahashi M, Uehara M, et al. Quantitative evaluation of right atrial volume and right atrial emptying fraction by 320-slice computed tomography compared with three-dimensional echocardiography. Int J Cardiol. 2011;146(1):96–9.CrossRefGoogle Scholar
  38. 38.
    Patel AR, Alsheikh-Ali AA, Mukherjee J, Evangelista A, Quraini D, Ordway LJ, et al. 3D echocardiography to evaluate right atrial pressure in acutely decompensated heart failure correlation with invasive hemodynamics. JACC Cardiovasc Imaging. 2011;4(9):938–45.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Diletta Peluso
    • 1
  • Marcelo Haertel Miglioranza
    • 2
    • 3
  1. 1.Cardiology UnitOspedale SS Giovanni e PaoloVeniceItaly
  2. 2.Cardiovascular Imaging Research and Innovation LabInstitute of Cardiology - University Foundation of CardiologyPorto AlegreBrazil
  3. 3.PREVENCOR—Mãe de Deus HospitalPorto AlegreBrazil

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