Dilated right ventricle on M-mode echocradiogram
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 echocradiogram PLAX view
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.
Intact interatrial septum
Intact interatrial septum (IAS) seen in a modified short axis view. RA: right atrium; TV: tricuspid valve (seen as thin leaflets just beyond the label; LA: left atrium; SVC (superior vena cava). Even there is an apparent tiny defect in the middle of the IAS, there is no definite flow across the IAS seen on colour Doppler. The defect could be region of the foramen ovale as well. A right to left shunt can occur across the stretched open foramen ovale in severe pulmonary hypertension when the right atrial pressure is very high.
Dilated pulmonary arteries
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
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.