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Acquired right ventricular dysfunction
  1. G B Bleeker1,
  2. P Steendijk1,
  3. E R Holman1,
  4. C-M Yu4,
  5. O A Breithardt5,
  6. T A M Kaandorp6,
  7. M J Schalij1,
  8. E E van der Wall1,
  9. J J Bax2,
  10. P Nihoyannopoulos6
  1. 1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
  3. 3Division of Cardiology, Prince of Wales Hospital, Shatin, NT, Hong Kong
  4. 4Department of Cardiology, Klinikum Mannheim, University of Heidelberg, Germany
  5. 5Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
  6. 6Imperial College London, NHLI & Cardiothoracic Directorate, Hammersmith Hospital, London, UK
  1. Correspondence to:
    Dr Petros Nihoyannopoulos
    Imperial College School of Medicine, Du Cane road, London W12 0NN, UK; p.nihoyannopoulos{at}

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Right ventricular (RV) function may be impaired either by primary right sided heart disease, or secondary to left sided cardiomyopathy or valvar heart disease. Two dimensional echocardiography is the mainstay for analysis of RV function. A detailed description of echocardiographic approaches for assessment of RV function is provided elsewhere.1 This brief review is focused on echocardiographic evaluation of right sided cardiac pathology.


The estimation of RV pressure is of great clinical importance since the RV pressure is equal to the pressure in the pulmonary artery, provided that there is no pulmonic stenosis. Typically, in RV pressure overload, the RV wall is thickened (> 4 mm) (often observed in congenital heart disease) or dilated (in acquired heart disease). In both situations, the RV free wall is hypokinetic, and is best appreciated from parasternal long axis projections. If an elevated pulmonary artery pressure is suspected, the shape of the interventricular septum should be evaluated. Normally, the shape of the left ventricular (LV) cavity will be circular because of the higher LV pressure throughout the cardiac cycle. However, in the presence of RV pressure overload, the interventricular septum will shift towards the LV and the septum will appear flattened during systole (D shape), which is best visualised on the parasternal short axis view, just below the mitral valve. The higher the RV pressure, the further the septum will displace into the LV resulting in a D shaped LV cavity (fig 1). Of note, septal flattening in the presence of elevated RV pressure should be distinguished from (isolated) RV volume overload, which leads to a septal flattening during diastole.2,3

Figure 1

 Parasternal short axis view during systole in a patient with severe right ventricle (RV) pressure overload. Note the flattening of the interventricular septum, the D shaped left ventricle (LV) and the enlarged …

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