We recently reviewed basic right heart anatomy and outlined the ASE updated recommendations for quantifying right heart size and function. For the 2nd part of our Right Heart blog series, we are going to discuss proper measurements for size evaluation of the right ventricle (RV).
The ASE suggests measuring the RV size in the RV Focused AP4 view. Remember, the right ventricle is a ‘crescent shaped structure that hugs the left ventricle, which is why we must strive to obtain as many views as possible to fully examine the size & structure. The RV Focused AP4 view is the specific RV view that allows the full visualization of the maximum diameter of the RV.
RV Focused AP4:
The ASE explained two methods for measuring the size of the RV:
ASE recommended method is via linear measurements over volumetric due to lack of advanced education in laboratories with 3DE.
The proximal RVOT can be measured in both the long and short axis parasternal windows.
The distal RVOT is measured in the short axis parasternal window.
ASE reference values for RV linear measurements are NOT based on BSA, gender or height. They have NOT been further classified into mild, moderate or severe.
Here is an easy reference chart to refer to in your scanning laboratory:
The Intersocietal Accreditation Commission (IAC) requires all echo reports to comment on the size and function of the right ventricle. We often review studies with no quantitative assessment of the RV yet the physician is required to report on RV size! We appreciate the time constraints that sonographers face so start by adding at least one RV diameter measurement. Both the mid and basal RV diameter measurements (RVD1, RVD2) are routinely implemented within scanning laboratories and have a wealth of published data for dimension references.
ASE recommends RV size quantification via linear measurements due to the wealth of published data for dimension references and its reproducibility. We reviewed the correct techniques and references ranges for measuring the right ventricle. If you are not currently measuring the RV as part of your routine study please start today! Join us in our mission to inspire excellence in imaging!
In the following weeks, we will discuss the proper methods for measuring the size of the RA and assessing the right ventricular function! We love your comments and questions so keep them coming and stay connected with us on Facebook, Twitter and LinkedIn.
Andrea Fields MHA, RDCS, Clinical Cardiac Director
Lang, R. M., MD, Badano, L. P., MD, & Mor-Avi, V., PhD. (2015). Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. JASE, 28(1), 1-53. Retrieved March 1, 2017, from http://asecho.org/wordpress/wp-content/uploads/2015/01/ChamberQuantification2015.pdf