Three-dimensional echocardiographic evaluation of the right ventricle

The right ventricle is a structurally and functionally complex chamber whose importance has been partially neglected previously. Right ventricular dimensions and function are known to be of diagnostic as well of prognostic importance in patients with cardiac disease.^1-6 Unfortunately an accurate and rapid non-invasive assessment of right ventricular performance is challenging due to the complex structure and anatomy of the ventricle and its unfavourable position in the thorax behind the sternum. The right ventricle is in fact composed by several anatomic and functional subunits extending from the tricuspid valve annulus to the proximal os infundibulum, then extending from the right ventricular outflow tract to the pulmonary valve as well as the right ventricular body extending to the apex. Understanding of right ventricular morphology in general is greatly aided by considering the ventricle in three parts: inlet, trabecular (apex) and outlet. The right ventricle is highly trabeculated, with several trabeculations including the septoparietal trabeculations and the moderator band. From a functional point of view, due to the orientation of right ventricular fibres, global assessment of the right ventricle is difficult with the two main portions of the right ventricle contracting perpendicular to each other: the proximal (inflow) longitudinally and the distal (outflow) circumferentially.