basicIII.F-001
State the RV basal diameter cutoff for RV dilation.
→ > 41 mm at the base in the RV-focused A4C view (mid > 35 mm). Measured with LV apex centered and the largest basal RV diameter shown.
basicIII.F-002
State the RV wall thickness cutoff for RV hypertrophy.
→ > 5 mm at end-diastole (measured in the subcostal view or the RV free wall in the parasternal view).
basicIII.F-003
List five ASE parameters for assessing RV systolic function and their cutoffs.
→ 1) RVEF < 45%. 2) RV FAC < 35%. 3) TAPSE < 17 mm. 4) RV S′ (TDI) < 9.5 cm/s. 5) RV GLS > −20% (less negative). 6) RIMP > 0.43 (PW) or > 0.54 (TDI).
basicIII.F-004
Why is RVEF normally lower than LVEF even when SV is equal?
→ RV end-diastolic volume is larger than LV EDV (~87 mL/m² vs ~64 mL/m² in men). Since EF = SV / EDV, the same SV from a larger EDV produces a lower EF.
basicIII.F-005
Why is TAPSE reduced after open-heart surgery even when RV function is preserved?
→ Pericardial adhesions restrict longitudinal (base-to-apex) motion. TAPSE reflects longitudinal displacement; radial function may be maintained.
basicIII.F-006
Interventricular septal flattening in systole vs diastole — what does each indicate?
→ Systolic flattening: RV PRESSURE overload (PAH, PS). Diastolic flattening: RV VOLUME overload (ASD, severe TR/PR).
basicIII.F-007
What is McConnell's sign?
→ Akinesis of the RV free wall with SPARING of the apex (the apex still contracts vigorously due to LV tethering). Suggests acute pulmonary embolism / RV pressure overload.
basicIII.F-008
Approximate PASP ceiling in acute massive PE?
→ ~60 mmHg. The thin-walled RV cannot acutely generate higher pressures; a value markedly above 60 suggests preexisting chronic PH.
basicIII.F-009
State the RA area cutoff for RA enlargement.
→ > 18 cm² in the RV-focused A4C view (end-systole).
basicIII.F-010
State the normal upper limits for TAPSE and RV S′.
→ TAPSE ≥ 17 mm. RV S′ (tissue Doppler tricuspid lateral annular systolic velocity) ≥ 9.5 cm/s.
basicIII.F-011
State the RV FAC formula.
→ RV FAC = (End-diastolic area − End-systolic area) / End-diastolic area × 100. Normal ≥ 35%.
basicIII.F-012
Ebstein's anomaly — key echo criteria for the tricuspid valve.
→ Apical displacement of the septal leaflet by > 8 mm/m² (BSA-indexed) or > 20 mm in absolute terms, with atrialization of the proximal RV. Severe TR is common. Often associated with WPW.
basicIII.F-013
What is Uhl's anomaly?
→ Congenital absence (partial or complete) of RV myocardium, leaving a paper-thin RV. Rare. May mimic ARVC clinically.
basicIII.F-014
What is the earliest echo finding of post-TOF repair to look for on follow-up?
→ Pulmonary regurgitation (from the RVOT patch) with progressive RV dilation. Long-term monitoring guides timing of pulmonary valve replacement (surgical or percutaneous).
basicIII.F-015
Why is 3D RV imaging preferred over 2D when available?
→ The RV's complex crescent shape violates the geometric assumptions of 2D formulas. 3D provides direct volume measurement; correlates better with cMRI-derived RVEF.
basicIII.F-016
State the ASE 2010 Rudski normal RVEDV index for men and women.
→ Men: ≤ 87 mL/m². Women: ≤ 74 mL/m². (Both larger than LV EDV indices — reflecting the crescent RV shape.)
basicIII.F-017
What is 'RV free-wall strain' and what abnormal cutoff is used?
→ RV free-wall longitudinal strain measured by speckle tracking. Normal is more negative than −20% (average of 3 segments). Values less negative than −20% (e.g., −15%) suggest RV dysfunction.
basicIII.F-018
Give three key echo findings of ARVC/D on Task Force Criteria.
→ 1) RV outflow tract diameter enlarged (> 32 mm end-diastole). 2) Regional RV free-wall dysfunction (aneurysm or dyskinesis). 3) Reduced RV FAC (< 33%) or RV EF (< 45% by cMRI). Also epsilon wave and T-wave inversions V1–V3 on ECG.
basicIII.F-019
Why is TAPSE reduced after cardiac surgery even if intrinsic RV function is preserved?
→ Pericardial adhesions restrict longitudinal (base-to-apex) motion of the RV; TAPSE reflects longitudinal displacement, so it drops even though radial and circumferential contraction may be preserved.
basicIII.F-020
State two Doppler indices that assess RV function independent of geometry.
→ 1) RIMP (Tei index) by PW Doppler (> 0.43 abnormal) or TDI (> 0.54 abnormal). 2) RV S′ velocity by TDI (< 9.5 cm/s abnormal).
basicIII.F-021
How does RV pressure overload differ from RV volume overload in septal motion timing?
→ Pressure overload (PAH, PS): septum flattens throughout systole → D-shaped LV in systole. Volume overload (severe TR/PR, ASD): septum flattens in diastole only (LV is normal shape in systole).
