22 nd Annual Conference of the Saudi Heart Association Echocardiographic Evaluation of Right Echocardiographic Evaluation of Right Echocardiographic Evaluation of Right Echocardiographic Evaluation of Right Riyadh, Saudi Arabia Echocardiographic Evaluation of Right Echocardiographic Evaluation of Right Ventricular Function in Ventricular Function in Congenital Heart Disease Congenital Heart Disease Echocardiographic Evaluation of Right Echocardiographic Evaluation of Right Ventricular Function in Ventricular Function in Congenital Heart Disease Congenital Heart Disease Congenital Heart Disease Congenital Heart Disease Congenital Heart Disease Congenital Heart Disease Benjamin W Eidem, MD, FACC, FASE Benjamin W Eidem, MD, FACC, FASE P f fP di t i &M di i P f fP di t i &M di i Benjamin W Eidem, MD, FACC, FASE Benjamin W Eidem, MD, FACC, FASE P f fP di t i &M di i P f fP di t i &M di i Professor of Pediatrics & Medicine Professor of Pediatrics & Medicine Divisions of Pediatric Cardiology& Cardiovascular Diseases Divisions of Pediatric Cardiology& Cardiovascular Diseases Mayo Clinic Mayo Clinic Professor of Pediatrics & Medicine Professor of Pediatrics & Medicine Divisions of Pediatric Cardiology& Cardiovascular Diseases Divisions of Pediatric Cardiology& Cardiovascular Diseases Mayo Clinic Mayo Clinic Mayo Clinic Mayo Clinic Mayo Clinic Mayo Clinic No Disclosures
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Echocardiographic Evaluation of Right Ventricular Function ... · Echocardiographic Evaluation of Right Ventricular Function in ... LV systolic functionLV systolic function LV global
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22nd Annual Conference of the Saudi Heart Association
Echocardiographic Evaluation of RightEchocardiographic Evaluation of RightEchocardiographic Evaluation of RightEchocardiographic Evaluation of RightRiyadh, Saudi Arabia
Echocardiographic Evaluation of Right Echocardiographic Evaluation of Right Ventricular Function in Ventricular Function in
Congenital Heart DiseaseCongenital Heart Disease
Echocardiographic Evaluation of Right Echocardiographic Evaluation of Right Ventricular Function in Ventricular Function in
Congenital Heart DiseaseCongenital Heart DiseaseCongenital Heart DiseaseCongenital Heart DiseaseCongenital Heart DiseaseCongenital Heart DiseaseBenjamin W Eidem, MD, FACC, FASEBenjamin W Eidem, MD, FACC, FASE
P f f P di t i & M di iP f f P di t i & M di iBenjamin W Eidem, MD, FACC, FASEBenjamin W Eidem, MD, FACC, FASE
P f f P di t i & M di iP f f P di t i & M di iProfessor of Pediatrics & Medicine Professor of Pediatrics & Medicine Divisions of Pediatric Cardiology& Cardiovascular Diseases Divisions of Pediatric Cardiology& Cardiovascular Diseases
Mayo ClinicMayo Clinic
Professor of Pediatrics & Medicine Professor of Pediatrics & Medicine Divisions of Pediatric Cardiology& Cardiovascular Diseases Divisions of Pediatric Cardiology& Cardiovascular Diseases
Mayo ClinicMayo ClinicMayo ClinicMayo ClinicMayo ClinicMayo Clinic
No Disclosures
Assessment of RV FunctionAssessment of RV FunctionObj tiObj ti
Assessment of RV FunctionAssessment of RV FunctionObj tiObj tiObjectivesObjectivesObjectivesObjectives
•• Review common nonReview common non--invasive methods of invasive methods of RV functional assessmentRV functional assessment
•• Review common nonReview common non--invasive methods of invasive methods of RV functional assessmentRV functional assessment•• 22--dimensional & 3dimensional & 3--dimensional imagingdimensional imaging•• DopplerDoppler--derived indicesderived indices•• 22--dimensional & 3dimensional & 3--dimensional imagingdimensional imaging•• DopplerDoppler--derived indicesderived indices
•• Advantages & limitations of quantitative Advantages & limitations of quantitative RV assessmentRV assessment
•• Advantages & limitations of quantitative Advantages & limitations of quantitative RV assessmentRV assessment
•• Emerging techniques to improve functional Emerging techniques to improve functional assessment of RV performanceassessment of RV performance
•• Emerging techniques to improve functional Emerging techniques to improve functional assessment of RV performanceassessment of RV performancepppp
Right Ventricular FunctionRight Ventricular FunctionB k dB k d
Right Ventricular FunctionRight Ventricular FunctionB k dB k dBackgroundBackgroundBackgroundBackground
•• Knowledge of RV Knowledge of RV function lags behind LVfunction lags behind LV
•• I d iti fI d iti f
•• Knowledge of RV Knowledge of RV function lags behind LVfunction lags behind LV
•• I d iti fI d iti f•• Increased recognition of Increased recognition of importance of RV importance of RV dysfunction in CV dysfunction in CV didi
•• Increased recognition of Increased recognition of importance of RV importance of RV dysfunction in CV dysfunction in CV dididiseasedisease
•• Challenges in the Challenges in the quantitative assessmentquantitative assessment
diseasedisease•• Challenges in the Challenges in the
quantitative assessmentquantitative assessment •• Publications (to present)Publications (to present)quantitative assessment quantitative assessment of RV structure & of RV structure & function function
quantitative assessment quantitative assessment of RV structure & of RV structure & function function
•• LV function (23,769)LV function (23,769)•• RV function (2,927)RV function (2,927)
Redington A, Cardiol Clin 2002Redington A, Cardiol Clin 2002
Right Ventricular FunctionRight Ventricular FunctionBackgroundBackground
Right Ventricular FunctionRight Ventricular FunctionBackgroundBackgroundBackgroundBackgroundBackgroundBackground
V diff t l b dV diff t l b d•• Very different vascular bedsVery different vascular beds•• RV external work is 25% of LV workRV external work is 25% of LV work
Diff tDiff t l l ti hil l ti hi
•• Very different vascular bedsVery different vascular beds•• RV external work is 25% of LV workRV external work is 25% of LV work
Diff tDiff t l l ti hil l ti hi•• Different pressure Different pressure -- volume relationshipsvolume relationships•• RV is very efficient systemRV is very efficient system•• Critically dependent upon low hydraulicCritically dependent upon low hydraulic
•• Different pressure Different pressure -- volume relationshipsvolume relationships•• RV is very efficient systemRV is very efficient system•• Critically dependent upon low hydraulicCritically dependent upon low hydraulic•• Critically dependent upon low hydraulic Critically dependent upon low hydraulic impedance of normal pulmonary vascular impedance of normal pulmonary vascular bedbed
•• Critically dependent upon low hydraulic Critically dependent upon low hydraulic impedance of normal pulmonary vascular impedance of normal pulmonary vascular bedbed
Right Ventricular FunctionRight Ventricular FunctionBackgroundBackground
Right Ventricular FunctionRight Ventricular FunctionBackgroundBackgroundBackgroundBackgroundBackgroundBackground
•• LV is a “square wave” pumpLV is a “square wave” pump•• RV performs under different RV performs under different
•• LV is a “square wave” pumpLV is a “square wave” pump•• RV performs under different RV performs under different
pressurepressure volume conditionsvolume conditionspressure pressure -- volume conditionsvolume conditions•• RV ejection very efficientRV ejection very efficient
•• Begins early during Begins early during
pressure pressure -- volume conditionsvolume conditions•• RV ejection very efficientRV ejection very efficient
•• Begins early during Begins early during pressure risepressure rise•• Occurs beyond Occurs beyond development of peak RV development of peak RV
pressure risepressure rise•• Occurs beyond Occurs beyond development of peak RV development of peak RV p pp ppressurepressure•• Continues as RV Continues as RV pressure fallspressure falls
p pp ppressurepressure•• Continues as RV Continues as RV pressure fallspressure fallspressure fallspressure fallspressure fallspressure falls
Redington A, Cardiol Clin 2002Redington A, Cardiol Clin 2002
•• Unique challenges with morphologic RVUnique challenges with morphologic RV•• GeometryGeometry
•• Unique challenges with morphologic RVUnique challenges with morphologic RV•• GeometryGeometryGeometryGeometry•• Anatomic locationAnatomic location•• Different hemodynamics compared to LVDifferent hemodynamics compared to LV
GeometryGeometry•• Anatomic locationAnatomic location•• Different hemodynamics compared to LVDifferent hemodynamics compared to LVDifferent hemodynamics compared to LVDifferent hemodynamics compared to LV
•• BeatBeat--toto--beat changes with respirationbeat changes with respiration•• Pulmonary vs systemic vascular bedPulmonary vs systemic vascular bed
Different hemodynamics compared to LVDifferent hemodynamics compared to LV•• BeatBeat--toto--beat changes with respirationbeat changes with respiration•• Pulmonary vs systemic vascular bedPulmonary vs systemic vascular bed•• Pulmonary vs systemic vascular bedPulmonary vs systemic vascular bed
•• Right Right -- left heart interactionleft heart interaction•• Pulmonary vs systemic vascular bedPulmonary vs systemic vascular bed
•• Right Right -- left heart interactionleft heart interaction
Evaluation of Ventricular FunctionEvaluation of Ventricular FunctionCongenital Heart DiseaseCongenital Heart Disease
Evaluation of Ventricular FunctionEvaluation of Ventricular FunctionCongenital Heart DiseaseCongenital Heart DiseaseCongenital Heart DiseaseCongenital Heart DiseaseCongenital Heart DiseaseCongenital Heart Disease
Challenges in congenitalChallenges in congenitalChallenges in congenitalheart diseaseChallenges in congenitalheart disease
Assessment of RV FunctionAssessment of RV FunctionQ lit ti Vi l A tQ lit ti Vi l A tAssessment of RV FunctionAssessment of RV FunctionQ lit ti Vi l A tQ lit ti Vi l A tQualitative Visual AssessmentQualitative Visual AssessmentQualitative Visual AssessmentQualitative Visual Assessment
Evaluation of Congenital Heart DiseaseEvaluation of Congenital Heart DiseaseSegmental ApproachSegmental Approach
Evaluation of Congenital Heart DiseaseEvaluation of Congenital Heart DiseaseSegmental ApproachSegmental ApproachSegmental ApproachSegmental ApproachSegmental ApproachSegmental Approach
H l ti L ft H tH l ti L ft H tGreat ArteriesGreat Arteries
Hypoplastic Left HeartHypoplastic Left Heart
Assessment of Assessment of LeftLeft Ventricular FunctionVentricular FunctionSegmental ApproachSegmental Approach
Assessment of Assessment of LeftLeft Ventricular FunctionVentricular FunctionSegmental ApproachSegmental ApproachSegmental ApproachSegmental ApproachSegmental ApproachSegmental Approach
LV systolic functionLV systolic function LV global functionLV global function• LVSF % and LVEF %• Stress-velocity index• LVSF % and LVEF %• Stress-velocity index
Assessment of Assessment of RightRight Ventricular FunctionVentricular FunctionSegmental ApproachSegmental Approach
Assessment of Assessment of RightRight Ventricular FunctionVentricular FunctionSegmental ApproachSegmental ApproachSegmental ApproachSegmental ApproachSegmental ApproachSegmental Approach
RV systolic functionRV systolic function RV global functionRV global function• RV FAC and RVEF %• RV dP / dt• RV FAC and RVEF %• RV dP / dt
• Myocardialperformance index
• Myocardialperformance index
• TAPSERV diastolic function
• TAPSERV diastolic function
• 3-D EchoRV longitudinal function
• 3-D EchoRV longitudinal function
• Tricuspid inflow Doppler
• Tricuspid inflow Doppler
• Tissue DopplerRV regional function
• Tissue DopplerRV regional function
• Hepatic venous Doppler
• RVOT Doppler
• Hepatic venous Doppler
• RVOT Doppler
• Strain and strain rate• Strain and strain rate
C di MRIC di MRI• RVOT Doppler• RVOT Doppler Cardiac MRICardiac MRI
Evaluation of RV FunctionEvaluation of RV FunctionRV Fractional Area & Volume ChangeRV Fractional Area & Volume Change
Evaluation of RV FunctionEvaluation of RV FunctionRV Fractional Area & Volume ChangeRV Fractional Area & Volume ChangeRV Fractional Area & Volume ChangeRV Fractional Area & Volume ChangeRV Fractional Area & Volume ChangeRV Fractional Area & Volume Change
•• GeometricGeometric•• GeometricGeometric•• Anterior RV free wallAnterior RV free wall•• Inclusion of RVOTInclusion of RVOT
•• GeometricGeometric•• Anterior RV free wallAnterior RV free wall•• Inclusion of RVOTInclusion of RVOT
55--231231--071071
Inclusion of RVOTInclusion of RVOTInclusion of RVOTInclusion of RVOT
Assessment of RV FunctionAssessment of RV Function33 Dimensional EchocardiographyDimensional EchocardiographyAssessment of RV FunctionAssessment of RV Function
Courtesy Phillips & G ShiraliCourtesy Phillips & G Shirali
Assessment of RV FunctionAssessment of RV Function33 Di i l E h di hDi i l E h di hAssessment of RV FunctionAssessment of RV Function
33 Di i l E h di hDi i l E h di h33--Dimensional Echocardiography Dimensional Echocardiography 33--Dimensional Echocardiography Dimensional Echocardiography
•• AdvantagesAdvantages•• AdvantagesAdvantages •• LimitationsLimitations•• LimitationsLimitations•• AdvantagesAdvantages•• QuantitativeQuantitative•• Global functionGlobal function
•• AdvantagesAdvantages•• QuantitativeQuantitative•• Global functionGlobal function
•• No geometric No geometric limitationslimitations•• No geometric No geometric limitationslimitations
Load dependentLoad dependent•• Regional functionRegional function
Load dependentLoad dependent•• Regional functionRegional function
•• ReproducibleReproducible•• Close correlation Close correlation with MRI volumeswith MRI volumes
•• ReproducibleReproducible•• Close correlation Close correlation with MRI volumeswith MRI volumeswith MRI volumeswith MRI volumeswith MRI volumeswith MRI volumes
Assessment of RV FunctionAssessment of RV FunctionDoppler EchocardiographyDoppler Echocardiography
Assessment of RV FunctionAssessment of RV FunctionDoppler EchocardiographyDoppler EchocardiographyDoppler Echocardiography Doppler Echocardiography Doppler Echocardiography Doppler Echocardiography
Ch ll i A t f RVCh ll i A t f RVCh ll i A t f RVCh ll i A t f RV•• Challenges in Assessment of RV Challenges in Assessment of RV physiologyphysiology•• Respiratory variationRespiratory variation
•• Challenges in Assessment of RV Challenges in Assessment of RV physiologyphysiology•• Respiratory variationRespiratory variation•• Respiratory variationRespiratory variation
•• Doppler measurements Doppler measurements 55--10% with 10% with inspirationinspiration
•• Respiratory variationRespiratory variation•• Doppler measurements Doppler measurements 55--10% with 10% with inspirationinspirationinspirationinspiration
•• Rate of rise of RV systolic Rate of rise of RV systolic pressure (dP /dt)pressure (dP /dt)
•• Rate of rise of RV systolic Rate of rise of RV systolic pressure (dP /dt)pressure (dP /dt)p ( )p ( )•• Velocity curve transferred to Velocity curve transferred to
pressure gradient curve via pressure gradient curve via modified Bernoulli equation modified Bernoulli equation
p ( )p ( )•• Velocity curve transferred to Velocity curve transferred to
pressure gradient curve via pressure gradient curve via modified Bernoulli equation modified Bernoulli equation od ed e ou equat ood ed e ou equat o(mean dP / dT)(mean dP / dT)
AdvantagesAdvantages•• DopplerDoppler--derivedderived•• ReproducibleReproducibleReproducibleReproducible•• Global functionGlobal function•• Clinical outcomeClinical outcome
ReproducibleReproducible•• Global functionGlobal function•• Clinical outcomeClinical outcome
•• LimitationsLimitations•• Signal qualitySignal quality
•• LimitationsLimitations•• Signal qualitySignal qualitySignal qualitySignal quality•• Signal availabilitySignal availability•• Normal valuesNormal values
Normal valuesNormal values•• Load dependentLoad dependent
Evaluation of RV FunctionEvaluation of RV FunctionVisual RV FunctionVisual RV Function
Evaluation of RV FunctionEvaluation of RV FunctionVisual RV FunctionVisual RV FunctionVisual RV FunctionVisual RV FunctionVisual RV FunctionVisual RV Function
8 yo critical PS s/p RVOT reconstruction8 yo critical PS s/p RVOT reconstruction
Assessment of RV FunctionAssessment of RV FunctionAssessment of RV FunctionAssessment of RV FunctionRV Fractional Area & Volume ChangeRV Fractional Area & Volume ChangeRV Fractional Area & Volume ChangeRV Fractional Area & Volume Change
RV FAC = 42%RV FAC = 42%RV FAC = 42%RV FAC = 42%
Assessment of RV FunctionAssessment of RV FunctionRV Diastolic FunctionRV Diastolic Function
Assessment of RV FunctionAssessment of RV FunctionRV Diastolic FunctionRV Diastolic FunctionRV Diastolic FunctionRV Diastolic FunctionRV Diastolic FunctionRV Diastolic Function
F d fl ith t i l t lF d fl ith t i l t lForward flow with atrial systoleForward flow with atrial systole
Assessment of RV Diastolic FunctionAssessment of RV Diastolic FunctionDoppler EchocardiographyDoppler Echocardiography
Assessment of RV Diastolic FunctionAssessment of RV Diastolic FunctionDoppler EchocardiographyDoppler EchocardiographyDoppler Echocardiography Doppler Echocardiography Doppler Echocardiography Doppler Echocardiography
•• Assessment of RV Assessment of RV physiology physiology -- ChallengesChallenges
RV i “ ” tRV i “ ” t
•• Assessment of RV Assessment of RV physiology physiology -- ChallengesChallenges
RV i “ ” tRV i “ ” t•• RV is an “open” system RV is an “open” system in diastolein diastole
•• Restrictive RVRestrictive RV
•• RV is an “open” system RV is an “open” system in diastolein diastole
•• Restrictive RV Restrictive RV conduitconduit•• Antegrade diastolic Antegrade diastolic ggforward flow into PA forward flow into PA during atrial systoleduring atrial systole
ggforward flow into PA forward flow into PA during atrial systoleduring atrial systole
Assessment of RV FunctionAssessment of RV FunctionMyocardial Performance IndexMyocardial Performance IndexAssessment of RV FunctionAssessment of RV FunctionMyocardial Performance IndexMyocardial Performance IndexMyocardial Performance IndexMyocardial Performance IndexMyocardial Performance IndexMyocardial Performance Index
•• DopplerDoppler--derived index derived index •• DopplerDoppler--derived index derived index •• Ratio of total time spent in Ratio of total time spent in
isovolumic activity divided isovolumic activity divided by the time spent inby the time spent in
•• Ratio of total time spent in Ratio of total time spent in isovolumic activity divided isovolumic activity divided by the time spent inby the time spent inby the time spent in by the time spent in ventricular ejectionventricular ejection
•• Increasing valuesIncreasing values of the of the MPI indicate orseningMPI indicate orsening
by the time spent in by the time spent in ventricular ejectionventricular ejection
•• Increasing valuesIncreasing values of the of the MPI indicate orseningMPI indicate orseningMPI indicate worsening MPI indicate worsening global ventricular functionglobal ventricular function
•• MPI has high correlationMPI has high correlation
MPI indicate worsening MPI indicate worsening global ventricular functionglobal ventricular function
•• MPI has high correlationMPI has high correlationMPI has high correlation MPI has high correlation with cath invasive with cath invasive measurements measurements (+) dP/dT ((+) dP/dT (--) dP/dT tau) dP/dT tau
MPI has high correlation MPI has high correlation with cath invasive with cath invasive measurements measurements (+) dP/dT ((+) dP/dT (--) dP/dT tau) dP/dT tau
•• Correlation with outcomeCorrelation with outcome(+) dP/dT, ((+) dP/dT, (--) dP/dT, tau) dP/dT, tau
•• Correlation with outcomeCorrelation with outcome
Assessment of RV FunctionAssessment of RV FunctionMyocardial Performance Index (n=243)Myocardial Performance Index (n=243)
Assessment of RV FunctionAssessment of RV FunctionMyocardial Performance Index (n=243)Myocardial Performance Index (n=243)Myocardial Performance Index (n=243)Myocardial Performance Index (n=243)Myocardial Performance Index (n=243)Myocardial Performance Index (n=243)
Assessment of RV FunctionAssessment of RV FunctionM di l P f I dM di l P f I dAssessment of RV FunctionAssessment of RV FunctionM di l P f I dM di l P f I dMyocardial Performance IndexMyocardial Performance IndexMyocardial Performance IndexMyocardial Performance Index
AdAdAdAd Li it tiLi it tiLi it tiLi it ti•• AdvantagesAdvantages•• DopplerDoppler--derivedderived•• Simple to performSimple to perform
•• AdvantagesAdvantages•• DopplerDoppler--derivedderived•• Simple to performSimple to perform
Evaluation of Ventricular FunctionEvaluation of Ventricular FunctionEvaluation of Ventricular FunctionEvaluation of Ventricular FunctionNew ModalitiesNew ModalitiesNew ModalitiesNew Modalities
Assessment of RV FunctionAssessment of RV FunctionTi D lTi D l
Assessment of RV FunctionAssessment of RV FunctionTi D lTi D lTissue Doppler Tissue Doppler Tissue Doppler Tissue Doppler
AdvantagesAdvantagesAdvantagesAdvantages Li it tiLi it tiLi it tiLi it ti•• AdvantagesAdvantages•• DopplerDoppler--derivedderived•• QuantitativeQuantitative
Effect of PR on Effect of PR on . Strain & SRStrain & SR.
cc
3.0
4.0
30
40 r=-0.53P<0.001r=-0.53P<0.001 r=-0.35
P<0.01r=-0.35P<0.01
se (%
)se
(%)
base
/sec
base
/sec
2.020
n R
V ba
sn
RV
bas
ate
RV
bat
e R
V b
0 0
1.0
0
10
Stra
inSt
rain
Stra
in ra
Stra
in ra
0.00 20 40 60 80
00 20 40 60 80
PR fraction (%)PR fraction (%)
SS
PR fraction (%)PR fraction (%)
Eyskens B et al: AEPC, 2004Eyskens B et al: AEPC, 2004
( )( ) ( )( )
Assessment of RV FunctionAssessment of RV FunctionSt i & St i R t I iSt i & St i R t I i
Assessment of RV FunctionAssessment of RV FunctionSt i & St i R t I iSt i & St i R t I iStrain & Strain Rate Imaging Strain & Strain Rate Imaging Strain & Strain Rate Imaging Strain & Strain Rate Imaging
Ad tAd tAd tAd t Li it tiLi it tiLi it tiLi it ti•• AdvantagesAdvantages•• DopplerDoppler--derivedderived•• QuantitativeQuantitative
High frame ratesHigh frame rates•• Data analysisData analysis
High frame ratesHigh frame rates•• Data analysisData analysis
Longitudinal & radial Longitudinal & radial functionfunction•• Early identification of Early identification of RV dysfunctionRV dysfunction
Longitudinal & radial Longitudinal & radial functionfunction•• Early identification of Early identification of RV dysfunctionRV dysfunctionRV dysfunctionRV dysfunction•• Clinical outcomeClinical outcomeRV dysfunctionRV dysfunction•• Clinical outcomeClinical outcome
Evaluation of Ventricular FunctionEvaluation of Ventricular FunctionS kl T kiS kl T ki
Evaluation of Ventricular FunctionEvaluation of Ventricular FunctionS kl T kiS kl T kiSpeckle TrackingSpeckle TrackingSpeckle TrackingSpeckle Tracking
Evaluation of Systemic RV FunctionEvaluation of Systemic RV FunctionPP V l R l ti hiV l R l ti hi
Evaluation of Systemic RV FunctionEvaluation of Systemic RV FunctionPP V l R l ti hiV l R l ti hiPressure Pressure -- Volume RelationshipVolume RelationshipPressure Pressure -- Volume RelationshipVolume Relationship
RV PRV P V l LV l L
Redington A, Cardiol Clin 2002Redington A, Cardiol Clin 2002
•• Similar to Similar to normal LV strain normal LV strain •• Similar to Similar to normal LV strain normal LV strain patternpatternpatternpattern
Petterson E, JACC 2007Petterson E, JACC 2007
Evaluation of Systemic RV FunctionEvaluation of Systemic RV FunctionVentricular Rotation & Torsion in DVentricular Rotation & Torsion in D TGATGAEvaluation of Systemic RV FunctionEvaluation of Systemic RV FunctionVentricular Rotation & Torsion in DVentricular Rotation & Torsion in D TGATGAVentricular Rotation & Torsion in DVentricular Rotation & Torsion in D--TGATGAVentricular Rotation & Torsion in DVentricular Rotation & Torsion in D--TGATGA
•• Normal LV & RVNormal LV & RV•• Normal LV & RVNormal LV & RV•• Clockwise rotation of Clockwise rotation of basebase
C t l k iC t l k i
•• Clockwise rotation of Clockwise rotation of basebase
C t l k iC t l k i•• Counterclockwise Counterclockwise rotation of apexrotation of apex
Systemic RVSystemic RV
•• Counterclockwise Counterclockwise rotation of apexrotation of apex
Systemic RVSystemic RV•• Systemic RVSystemic RV•• Absence of rotationAbsence of rotation•• Absence of torsionAbsence of torsion
•• Systemic RVSystemic RV•• Absence of rotationAbsence of rotation•• Absence of torsionAbsence of torsionAbsence of torsionAbsence of torsion
RVRV LV d f ti ttLV d f ti tt•• sRV sRV LV deformation patternLV deformation pattern•• Myocardial dysfunction in systemic RVMyocardial dysfunction in systemic RV
•• sRV sRV LV deformation patternLV deformation pattern•• Myocardial dysfunction in systemic RVMyocardial dysfunction in systemic RV
•• strain ratestrain rate•• Absence of twist & torsionAbsence of twist & torsion
•• strain ratestrain rate•• Absence of twist & torsionAbsence of twist & torsion