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Focused Cardiac Ultrasound

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  1. Welcome

    Introduction to FoCUS
    2 Topics
  2. Section 1
    Video: Cardiac Anatomy
  3. Cardiac Anatomy
    3 Topics
  4. Section 2
    Key Video: Obtaining the 5 Views
  5. Acquisition & the 4Ps
    4 Topics
    |
    1 Quiz
  6. Acquiring The 5 Views
    5 Topics
    |
    1 Quiz
  7. Clinical Case Scenario
  8. Section 3
    Interpretation
    11 Topics
    |
    2 Quizzes
  9. Interpretation: The RUSH Protocol
    1 Quiz
  10. Section 4
    Medical Management
  11. Foundations of Echocardiography
  12. References
    References & Further Reading

Quizzes

Focused Cardiac Ultrasound Cardiac Anatomy Right Heart
Lesson 3, Topic 2
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Right Heart

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Right Heart

Right Atrium

The right atrium receives blood from the superior and inferior vena cava, thebesian veins and coronary sinus. It is ellipsoid in shape and consists of three parts – a venous component, an appendage and a vestibule. It is located anterolateral to the left atrium and superior to the right ventricle.

Right Ventricle

Investigation and understanding of the often overlooked right ventricle has gained significance over the past 2 – 3 decades.

 Anatomical features of the right ventricle demonstrating the internal structures discussed. (Illustration by Katie Yost ©2019, provided under CC-BY–NC–ND).

The right ventricle can be divivded into 3 parts:

  1. The inlet – Including the tricuspid valve, chordae tendinae & papillary muscles.
  2. Trabeculated myocardium.
  3. The outlet – including the infundibulum or conus and the pulmonary valve

Right ventricular anatomical features:

  • The right ventricle is the most anterior structure of the heart, lying directly behind the sternum.
  • It forms the inferior cardiac border, lying nearly horizontal to the diaphragm.
  • The RV is convex anteriorly. It appears triangular when viewed from the side and crecenteric in cross section.
  • As the heart is positioned obliquely, the RV apex is inferior to the LV apex.
  • It is a hollow muscular chamber that is heavily trabeculated, receiving blood from the right atrium and pumping it through the outflow tract to the pulmonary trunk.
  • Wall thickness is 2-5mm, composed of deep and superficial muscle layers.
  • The deep fibres are arranged longitudinally from base to apex.
  • The supeficial fibres are arranged circumferentially, turning obliquely at the apex of the base and continue into the LV. This accounts for ventricular interdependence.
  • The interventricular septum makes up the left and posterior border of the RV, the septum being concave towards the LV.
  • The moderator band or septo-marginal trabecula extends from the interventricular septum to the margins of the right ventricle, attaching to the base of the anterior papillary muscle.
Arrow points to moderator band in the RV. Image courtesy of A/Prof Abhilash Koratala.

Tricuspid Valve

The tricuspid valve can be divided into 5 components:

  • Valve Orrifice – Triangular in shape with 3 margins; the anterosuperior, inferior and septal.
  • Annulus
  • Leaflets – Trileaflet valve; Anterosuperior leaflet (largest), inferior and septal leaflet. The valve behaves like a bileaflet valve, with the septal leaflet being fixed.
  • Chordae Tendinae – True and False Chords, the former connect papillary muscles to leaflets.
  • Papillary Muscles – 3 muscles – Anterior, Inferior and Septal or Medial
Illustration by Katie Yost ©2019, provided under CC-BY–NC–ND.

Pulmonary Valve

This is the most superior of the 4 heart valves. Located at the distal end of the right ventricular outflow tract at the junction of the pulmonary artery, the pulmonary valve (PV) normally is comprised of three equal-sized, semilunar cusps or leaflets (right, left, anterior).