Echocardiogram in severe pulmonary hypertension

Echocardiogram in severe pulmonary hypertension

Dilated right ventricle on M-mode echocardiogram in severe pulmonary hypertension
Dilated right ventricle on M-mode echocardiogram in severe pulmonary hypertension

Dilated right ventricle (RV) on M-mode echocardiogram. IVS: interventricular septum; LV: left ventricle; LVPW: left ventricular posterior wall; LA: left atrium; LVIDs: left ventricular internal diameter, systolic; LVPWd: left ventricular posterior wall, diastolic; LVIDd: left ventricular internal diameter, diastolic; IVSd: interventricular septum, diastolic; EDV: end diastolic volume (of left ventricle); FS: fractional shortening (of left ventricle); ESV: end systolic volume (of left ventricle); EF: ejection fraction (of left ventricle); IVS/LVPW: septal to posterior wall ratio (important in asymmetric septal hypertrophy seen in hypertrophic cardiomyopathy ). When the right ventricle is dilated due to volume overload as in atrial septal defect, the septal motion becomes paradoxical (moves towards the right ventricular free wall in systole). Here the septal motion is towards the left ventricle in systole and suggests that the right ventricular enlargement is due to pressure overload rather than volume overload. Estimation of ejection fraction by M-mode becomes erroneous if paradoxical septal motion is present.

Dilated right ventricle on echocardiogram PLAX view in severe pulmonary hypertension
Dilated right ventricle on echocardiogram PLAX view in severe pulmonary hypertension

Dilated right ventricle (RV) seen on parasternal long axis (PLAX) view. LV: left ventricle; LA: left atrium; Ao: aorta. There is a trivial mitral regurgitation jet seen in the left atrium as a blue jet in the left frame, with the mitral valve in closed position (systole), which is of no practical significance.

Dilated pulmonary arteries in severe pulmonary hypertension
Dilated pulmonary arteries in severe pulmonary hypertension

Dilated main pulmonary artery (MPA), left pulmonary artery (LPA) and right pulmonary artery (RPA) on short axis view of 2-D echocardiogram. Ao: aorta. Usually the aorta main pulmonary artery are of comparable size. Here the main pulmonary artery is grossly dilated and about twice the size of aorta, due to severe pulmonary hypertension.

TR gradient in severe pulmonary hypertension
TR gradient in severe pulmonary hypertension

Tricuspid regurgitation (TR) gradient in severe pulmonary hypertension of 101 mm Hg. The TR jet is incompletely visualised. Estimated right ventricular systolic pressure (RVSP) is obtained by adding the right atrial pressure to this value (taken as 10 mm Hg nominally). Since the velocity is very high interrogation is done using CW (continuous wave) Doppler.

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