Echocardiographic Assessment of Right Ventricular Volume and Function

Echocardiographic evaluation of right ventricular volume and function has become a subject of growing interest with the increasing awareness of the important role of the right ventricle in the entire circulation. However, the anatomically complex and load-dependent shaped right ventricle shape is difficult to describe by a simple geometric figure and its volume and function are, therefore, difficult to assess in a simple manner. A number of echocardiographic methods for evaluating right ventricular volume and function have emerged; to date, however, their quantification remains a clinical challenge. The major goal is to develop a reproducible method that will allow for quantitative comparisons between patients or serially within a given patient. This discussion examines the available methods with specific attention to their reliability and limitations. Visual inspection or measurement of single plane indices is limited by their lack of standardization and failure to describe the entire right ventricle. Simpson's rule requires computer calculations and assumes an elliptic symmetry present in the left, but not the right ventricle. Application of the area-length method to the subcostal outflow tract and apical four-chamber views is a particularly practical current approach. Three-dimensional echo reconstruction, which eliminates the need for geometric assumptions and individual standardized views, although only in its infancy, promises to be the most accurate method for right ventricular volume calculation and in the future should emerge as the standard for research and many clinical applications.