ANGLE BETWEEN THE RIGHT VENTRICULAR FREE WALL AND THE INTERVENTRICULAR SEPTUM AT THE APEX AS A MARKER OF PULMONARY HYPERTENSION Grant uri icon

abstract

  • Pulmonary Hypertension (PH) is a progressive and fatal disease which is defined by an elevation ;of mean pulmonary artery pressure (mPAP) >25 mm Hg. The currently available screening test for ;pulmonary hypertension is echocardiographic estimation of pulmonary artery systolic pressure based ontricuspid regurgitation (TR-Jet) velocity. Estimation of the TR jet velocity is prone to errors of under and ;over estimating the Right ventricular Systolic pressure1 due to poor acoustic windows, inadequate ;doppler envelope and improper angulation of the probe. ;The ideal screening test for pulmonary hypertension should be able to detect disease even before ;the Tricuspid regurgitation jet can be detected. Unfortunately, for Pulmonary Hypertension, the ideal ;screening test that is sensitive as well as specific, non-invasive, widely available, inexpensive, and able to ;detect disease at an early stage in not yet available.
    Functionally the Right Ventricle(RV) contracts in both longitudinal and transverse planes. The ;tricuspid annulus and the free wall of the RV move as if hinged, creating a sweep towards the RV outflow ;tract. Free wall of the RV contracts in a peristaltic wave like fashion starting at the base and progressingto the apex and contributes to the initial part of RV ejection. ;The Right ventricular apex is the point of attachment of the RV free wall to the septum. In the ;normal Right Ventricle, the apical region narrows as it curves past the moderator band towards the apex. ;This portion is heavily trabeculated, not as contractile and will not participate as much in flow exchange. ;However the residual volume of blood at the apex may act as padding, preserving kinetic energy and ;aiding in smooth redirection of the high-velocity inflow blood towards the outflow tract. In a recently ;published 3D echo based study in patients with pulmonary hypertension, both RV global functionparameters and regional strain indices of the apex appeared to detect early signs of ventricular failure. ;Their use could improve the evaluation of subtle RV changes in the first stages of PH when TAPSE(a marker ;of longitudinal contraction of the RV) is known to be normal. In patients with pulmonary hypertension ;we have observed that the compact angle of the apex of the right ventricle becomes splayed.

date/time interval

  • February 2016 - January 2019