is an echo the best right heart catheter? · 2016. 8. 18. · • alignment. atria j am soc...

Is an echo the best rightheart catheter?

PD Dr med. Bernhard Herzog

No disclosures

Can echo answer myquestion?

Right Heart Disease

Tricuspid valve disease

Right Ventriular Infarction

Pulmonary Hypertension

Pulmonary valve disease

ARVC

Shunts

Right Heart Disease

Size & Function- Right Ventricle- Left Ventricle

Size- Atria- MPA / PAs- Inferior Vena Cava

Morphology & Function- Tricuspid Valve- Pulmonary Valve- Mitral Valve- Aortic Valve

Pulmonary Pressure

Tricuspid valve disease

Right Ventriular Infarction

Pulmonary Hypertension

Pulmonary valve disease

ARVC / Sarcoidosis

Shunts

Right Ventricular Size

RV linear dimensions

- inflow

RV linear dimensions

- outflow

RV end-diastolic area

RV 3D volume

J Am Soc Echocardiogr 2015;28:1-39

RV modified / focusedapical 4CH

J Am Soc Echocardiogr 2010;23:685-713

Right Ventricular Size - Limitations- Image Quality-

?

Right Ventricular Size - Limitations- Image Plane-

J Am Soc Echocardiogr 2015;28:1-39

?

Right Ventricular Size - Limitations

• Image Quality

• Image Plane

• Trabeculations

X

Right Ventricular Size - Limitations

• Image Quality

• Image Plane

• Trabeculations

• Normal Values

Right Ventricular Function

FAC

3D function

RV longitudinal functionTAPSE

Color tissue Doppler

S wave

Pulsed tissue Doppler

S wave

Global longitudinal strain

J Am Soc Echocardiogr 2015;28:1-39

RIMP PW

RIMP TDI

Right Ventricular Function- Limitations

• Image Quality

• Image Plane

• Trabeculations

• Normal Values

• Alignment

Atria

J Am Soc Echocardiogr 2015;28:1-39

LA RA

MPA / PAs & IVC

Pulmonary Hypertension

Pulmonary Hypertension

Pulmonary Hypertension - Limitations

• Image Quality

• Image Plane

• Trabeculations

• Normal Values

• Alignment

• Severity of tricuspid regurgitation

• Right ventricular function

• Inspiration (higher with inspiration)

• Echo is the first line modality

• Echo is not a right heart catheter

• RV assessment is challenging – NOT only for echo

• Get as many pieces of the puzzle as possible

• Take other imaging modalities if necessary

Take Home Message