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LETTER TO THE EDITOR
Year : 2013  |  Volume : 8  |  Issue : 2  |  Page : 127
Evaluation of right ventricle with echocardiography: Utility of combined techniques


1 Department of Cardiology, Gulhane Military Medical Faculty, Ankara, Turkey
2 Department of Cardiology, Malatya Army Hospital, Malatya, Turkey

Date of Web Publication30-Mar-2013

Correspondence Address:
Emre Yalcinkaya
Department of Cardiology, Gulhane Military Medical Faculty, Ankara
Turkey
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DOI: 10.4103/1817-1737.109842

PMID: 23741278

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How to cite this article:
Yalcinkaya E, Bugan B, Celik M, Yuksel UC. Evaluation of right ventricle with echocardiography: Utility of combined techniques. Ann Thorac Med 2013;8:127

How to cite this URL:
Yalcinkaya E, Bugan B, Celik M, Yuksel UC. Evaluation of right ventricle with echocardiography: Utility of combined techniques. Ann Thorac Med [serial online] 2013 [cited 2019 Dec 16];8:127. Available from: http://www.thoracicmedicine.org/text.asp?2013/8/2/127/109842


Sir,

We read with great interest the article by Idrees, et al.[1] entitled "Novel approach for the management of sub-massive pulmonary embolism," which is published in the previous issue of Annals of Thoracic Medicine.

They hypothesized that using inhaled prostacyclin is beneficial in improving right ventricular (RV) functions in patients with sub-massive pulmonary embolism. In this study, RV dysfunction was assessed by quantitative and qualitative criterias, which is based on the increase in RV diameters in a two-dimensional (2D) echocardiography.

Assessing RV morphology and function are of paramount importance in diseases, such as pulmonary embolism, pulmonary hypertension, myocardial infarction involving the RV, and left ventricular dysfunction.

Echocardiography, being non-invasive, widely available, relatively inexpensive, and having no side effects, is the modality of choice for the assessment of morphology and function of the RV in clinical practice. Echocardiographic volume and function assessment of the RV are complicated by the complex geometry of this chamber, the pronounced trabeculation that compromises accurate endocardial delineation, and the anterior position that often limits echo image quality. [2],[3],[4]

Unlike the LV, where biplane methods are accepted and widely used for a global assessment of systolic function, identification of functional abnormalities on the basis of visual echocardiographic assessment solely is inaccurate, frequently resulting in false-positive findings. [4],[5]

In conclusion, owing to the incomplete visualization and evaluation of the RV in a single 2D echocardiographic view as in this study, combined projections such as three-dimensional echocardiography, right ventricular fractional area change (RVFAC), myocardial performance index (MPI, Tei index), RV dP/dt, tricuspid annular plane systolic excursion (TAPSE), doppler myocardial imaging techniques (pulsed, colour and tissue), tricuspid and hepatic flow patterns, and inferior vena caval diameters are needed for a comprehensive evaluation of RV structure and function.

Combinations of these parameters in evaluating RV dysfunction give more accurate information, which could make studies more valuable.

 
   References Top

1.Idrees MM, Batubara E, Kashour T. Novel approach for the management of sub-massive pulmonary embolism. Ann Thorac Med 2012;7:157-61.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.D'Oronzio U, Senn O, Biaggi P, Gruner C, Jenni R, Tanner FC, et al. Right heart assessment by echocardiography: gender and body size matters. J Am Soc Echocardiogr 2012;25:1251-8.  Back to cited text no. 2
    
3.Sheehan F, Redington A. The right ventricle: Anatomy, physiology and clinical imaging. Heart 2008;94:1510-5.  Back to cited text no. 3
    
4.Jurcut R, Giusca S, La Gerche A, Vasile S, Ginghina C, Voigt JU. The echocardiographic assessment of the right ventricle: What to do in 2010? Eur J Echocardiogr 2010;11:81-96.  Back to cited text no. 4
    
5.Ho SY, Nihoyannopoulos P. Anatomy, echocardiography, and normal right ventricular dimensions. Heart 2006;92:i2-i13.  Back to cited text no. 5
    



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