RV Function 2

This station covers the evaluation of RV function. We will look at how to perform the TAPSE measurement, TR jet peak gradient and pulmonary acceleration time measurement.

A. TAPSE

Tricuspid Annular Plane systolic Excursion (TAPSE):

  • Obtain  an apical 4 chamber view, preferably the RV focused view
  • Use M-Mode
  • Align the M-Mode cursor across the lateral annulus of the tricuspid valve
  • Obtain the M-Mode tracing of TAPSE
  • Measure the displacement of the lateral annulus in systole.
  • < 17mm indicates abnormal RV function

B. Tricuspid Regurgitation Jet Peak Gradient

Image From European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: Mitral and tricuspid regurgitation (native valve disease). Lancelotti et al. EHJ May 2010
  • The Apical 4 Chamber RV Focused view is useful to evaluate TR
  • If present, the TR jet can be used Right Ventricular Systolic Pressure (RVSP) and Systolic Pulmonary Artery Pressure (SPAP)
  • RVSP = TR Peak Gradient + CVP
  • A TR peak gradient of < 60mmHg, with a pulmonary acceleration time of <60ms has high specificity for acute pulmonary embolism. This is the 60/60 sign

C. Pulmonary Acceleration Time

Image from: Pulmonary Artery Acceleration Time Provides a Reliable Estimate of Invasive Pulmonary Hemodynamics in Children. Levy et al. JASE 2016
  • Obtain the PSAX view ath the aortic valve level
  • Identify the pulmonary valve
  • Use pulse wave doppler
  • Place the sample volume at the pulmonary valve
  • Trace the doppler envelope
  • Pulmonary artery acceleration time is the time taken to reach peak velocity
  • The time reduces as pulmonary pressures increase
  • This sign is part of the 60/60 sign

Workshop Stations

LV Systolic Function 2

LV Systolic Function 3

eFAST

RV Function 1

RV Function 2