右心超声检查规范-ase指南解析

,第四军医大学唐都医院超声科 袁丽君,超声心动图评价右心大小及功能,评价右心室常用切面-胸骨旁切面,右室是否扩大右室壁厚度RVOT内径受检查者手法影响,显示RVOT长轴肺动脉瓣和主肺动脉用于测量肺动脉瓣环用于评估肺动脉瓣,右室前壁/下壁三尖瓣前叶和后叶前、后乳头肌腱索附着情况下腔静脉开口欧氏瓣TR jet,右室前壁基底段RVOTTV，PV，RA测量RVOT内径TR jet房水平分流,PV，PA及分叉测量肺动脉瓣环内径、肺动脉PA血流,基底水平RV前壁、下壁和侧壁月牙形RVRV容量或压力负荷增大后室间隔扁平可评价RV大小，但不能用来评价收缩功能,中部水平RV前壁、下壁和侧壁月牙形RVRV容量或压力负荷增大后室间隔扁平RV大小，收缩功能不可,RV/RA大小、形态、功能RV最大、最小长径、RV 面积变化百分比RA内径、面积、容积RV流入道血流TR jetTAPSERV strain,评价右心室常用切面-心尖切面,RV基底部最小径测量RV/RA大小、形态、 功能；RV游离壁更清 晰TR jet,RV侧壁右房斜切面不适宜评价定量RV/RA大小可以评价TV inflow and TR jet,RV前侧壁调节束TR jet,RV后侧壁冠状静脉窦TR jet,评价右心室常用切面-剑下切面,RV壁厚度最好切面心包填塞时RV塌陷ASD&PFO可以评价TV inflow and TR jet,RV基底部分，包括RV流入道、流出道、肺动脉瓣、肺动脉及其分支可用于测量RVOT漏斗部、肺动脉瓣及肺动脉的多普勒,右心大小测定,心尖四腔切面舒张末期,右室（RV）大小,RV扩大：RVD142mm, RVD235mm；RVD386mm,右房（RA）大小,舒张末期RA 面积18cm2RA最长径53mmRA最小径44mm,右房扩大,右室流出道（RVOT）,A,远端RVOT27mm，增宽,近端RVOT33mm，增宽,右室壁厚度,剑下切面或左室长轴切面,下腔静脉（IVC）内径及意义,肝静脉入口处测量,吸鼻时IVC内径 2.1cm，内径塌陷50% RA压力3mmHg（0-5mmHg）,吸鼻时IVC内径2.1cm，内径塌陷50% RA压力15mmHg（10-20mmHg）,8mmHg,右室收缩功能,TAPSE (Tricuspid Annular Plane Systolic Excursion) 三尖瓣环收缩期位移,代表右室长轴方向的收缩功能,特异性高敏感性低,17mm，收缩功能下降,三尖瓣环组织多普勒 s 速度,10mm，收缩功能下降,二维：右室面积变化百分比（FAC，%）,FAC =（舒张末期面积-舒张末期面积）/ 舒张末期面积 100%FAC35% 右室收缩功能减低,RV Tei 指数,频谱多普勒,组织多普勒,0.4,0.55,*右房压升高时，Tei指数可能假性变小,E,Tei=(IVRT+IVCT)/ET,右室舒张功能,RV 舒张功能分级,级 松弛性下降：三尖瓣血流E/A比值0.8级 假性充盈正常：E/A比值=0.8 2.1, E/e 6级 限制性充盈：E/A比值2.1, DT120ms,肺动脉压力及阻力,右室收缩压和肺动脉收缩压,三尖瓣反流速度 2.8 2.9m/s, 右室收缩压35-36mmHg ，假设RA压力35mmHg，则肺动脉收缩压视为正常非常严重的三尖瓣反流时，RV-RA压力迅速平衡会导致三尖瓣反流频谱不完整显示，容易低估肺动脉压,速度1与平均肺动脉压相关速度2与肺动脉舒张压相关,肺动脉舒张压,右室压力负荷过重,右室容量负荷过重,收缩末期,收缩中期,舒张末期,收缩末期,收缩中期,舒张末期,肺血管阻力（PVR）,PVR =（TR最大速度/RVOT VTI） 10 0.16,（TR最大速度/RVOT VTI比值应0.15）,右心室冠状动脉供血,Echocardiographic assessment of the right ventricle has been largely qualitative, primarily because of the difficulty with assessing RV volumes because of its unusual shape. Hence, there are minimal quantitative data overall on RV size and function in normal controls and in disease states. A gradual shift to more quantitative approaches for the assessment of RV size and function will help standardize assessment of the right ventricle across laboratories and allow clinicians to better incorporate assessment of the right heart into an echocardiographic evaluation. Improvements in 3D imaging will result in increased use and have the potential to help in the clinical assessment of RV size and function.,指南结语,This guidelines document provides clinicians basic views to assess the right ventricle and right atrium, the various parameters to assess RV systolic and diastolic function, and the normal reference values from pooled data. This will enable echocardiographers to distinguish an abnormal right ventricle from a normal one. It is hoped that this document will lead to further work in establishing normal ranges in larger populations and that the application of the values included will enhance the value of echocardiography in recognizing RV dysfunction in clinical practice, in improving disease detection and in patient follow-up.,Upon completing the reading of this article, the participants will better be able to:Describe the conventional two-dimensional acoustic windows required for optimal evaluation of the right heart.Describe the echocardiographic parameters required in routine and directed echocardiographic studies, and the views to obtain these parameters for assessing right ventricle (RV) size and function.Identify the advantages and disadvantages of each measure or technique as supported by the available literature.Recognize which right-sided measures s