Historically, the right ventricle dimensions have been measured in M-mode obtained from the parasternal long axis view
A rough measure of the dimensions of the right ventricle is given on the FATE card
On the M-mode recording:
1) Mark the AV-plane in diastole at the R-wave or the longest distance from the top of the M-mode image
2) Mark the AV-plane in systole – shortest distance from the systolic top of the M-mode recording to the AV-plane in diastole
3) Measure the distance = dimensional change from diastole to systole
4) Use the FATE card for normal values and conversion to EF
Normal MAPSE value > 11 mm
In clinical practice the right ventricular systolic function is less frequently evaluated than the left ventricular systolic function
EF is generally not reported due to ill-suited geometry
Simple qualitative judgment of the size of the right ventricle is the most common method for assessment of the right ventricle
All 4 FATE views can be used for eyeballing of the right ventricular function
Normal size of the right ventricle is approximately 2/3 of the left ventricle (A4CH view)
The apical 4 chamber view (A4CH) is used for semi-quantitative measurement of right ventricular function – tricuspid annular plane systolic excursion (TAPSE) is the preferred method since longitudinal contraction predominates
Right ventricle enlargement and myocardial dysfunction is seen in right side myocardial infarction and pressure increase (pulmonary embolism and chronic pulmonary hypertension)
In acute enlargement the high pressure in the right ventricle will compress the left ventricle resulting in typical paradoxical interventricular septal movement and D-shape of the left ventricle
The tricuspid annular plane systolic excursion (TAPSE) is obtained from M-mode recording in position 2 – the apical 4 chamber (A4CH) view
TAPSE is given by the movement of the atrio-ventricular plane during systole
On the screen:
1) Display the correct apical 4 chamber view
2) Activate the cursor
3) Place the cursor line through the AV plane on the right side
4) Activate M-mode recording
5) Freeze the image when correct M-mode recording is obtained
On the screen:
1) Display the parasternal long axis view (PLAX)
2) Make sure you transect the LV so it appears at its largest
3) Freeze a full cine loop covering a whole heart cycle
4) Use the trackball to scroll to diastole (just before the aortic valve opens)
5) Activate the measurement button (machine dependent)
6) Measure as perpendicularly to the septum and posterior wall as possible
7) Measure only the free of the tip of the mitral leaflets
8) Repeat for systole when convenient
On the screen:
1) Display the correct PLAX view
2) Activate the cursor
3) Place the cursor line at the tip of the anterior mitral leaflet
4) Activate M-mode recording
5) Freeze the image when correct M-mode recording is obtained
6) Measure the shortest distance between the interventricular septum and anterior mitral leaflet = MSS = Mitral septal separation
7) Mitral septal separation (MSS) should be less than 1 cm
On the screen:
1) Display the correct apical 4 chamber view
2) Activate the cursor
3) Place the cursor line through the AV plane on the lateral wall
4) Activate M-mode recording
5) Freeze the image when correct M-mode recording is obtained
The videos below show PLAX views from 4 hearts with different degrees of impaired left systolic function
Watch the hearts and observe the mitral septal separation by simple eyeballing
A, B and D show abnormal MSS (> 1 cm), while C shows normal MSS
