TEE CHART - RV DYSFUNCTION

TEE chart - RV DYSFUNCTION

Parameters                      Normal                                   RV dysfunction

Shape of RV                         Triangular                                    Round or Ellipsoid

RV Mass                                RV mass< LV                              Equal or RV mass more than LV

Cardiac Apex                        LV                                                 RV

RV wall thickness                <5 mm                                         >7 mm

RV area                                < 60% of LV                                  Mild > 60 % of LV

                                                                                                     Moderate RV=LV

                                                                                                     Severe RV > LV area

IVS shape                             convex                                          Flat

EF                                          45-65%                                         <45%

FAC                                       32-60%                                         Mild-25-31%,Mod-18-24%,Sev-<18%

TAPSE                                  > 21 mm                                        <15 mm

TAV                                      > 11.5 cm/sec                               < 10.5 cm/sec

dP/dT                                   >1100mmHg/s                             < 1100mmHg/s

MPI/Tei Index                      0.2-0.4                                          >0.5

TR jet                                  Mild                                                  Moderate to Severe

Hepatic vein flow             S>D                                                   S< D or Systolic Reversal

IVC size                               < 17 mm                                          > 17 mm

IVC respiratory variation    >50%                                            < 50%

Diastolic dysfunction        Normal peak E-wave velocity is 45+/-7.5cm/s and peak A wave velocity 30+/-8.1cm/s. DD of RV is characterized by impaired relaxation with A > E or restriction when E >>> A.

A TAPSE < 8.5 mm correlates with a RVEF < 25% and a TAPSE < 15 mm demonstrates a more significant reduced right ventricular ejection fraction.

Elevated RA pressure is associated with RV dysfunction: IVC dilation, enlarged hepatic veins, coronary sinus, RA and bowing of the IAS towards the RA, HVF: diastolic predominance and ratio of transtricuspid flow- E/E’ >6 associated with mean RAP>10 mmHg in spontaneously breathing subjects.

References –

Textbooks -Problem Based Transesophageal Echocardiography – Deepak Tempe

                  Comprehensive Textbook of Perioperative Transesophageal Echocardiography – Robert Savage

Tricuspid Valve and Pulmonic Valve  Mark A. Taylor, MD, FASE

Assessment of Right Ventricular Anatomy and Function Nikolaos J Skubas, MD, FASE

- by Dr Amarja