Chronic pulmonary hypertension

Images by Genevieve Carbonatto

Parasternal long axis, (PLAX) of the left ventricle with the probe tilted slightly towards the right hip showing a dilated right ventricle, (RV).  There is elongation and thickening of the  anterior mitral valve leaflet.

Parasternal long axis, (PLAX) of the left ventricle with the probe tilted slightly towards the right hip with colour across the mitral valve.  The colour demonstrates at least moderate mitral regurgitation.

Parasternal long axis, (PLAX) of the right ventricular inflow  with the probe tilted from the PLAX LV more towards the right hip.  The view shows the RV, tricuspid valve,  right atrium, (RA) with the coronary sinus entering the RA superior to the posterior TV leaflet.  The prominent “Q” tip is a normal variant, (part of the Eustachian valve), be careful not to call abnormal.

Parasternal long axis, (PLAX) of the right ventricular inflow, with colour across the tricuspid valve showing tricuspid regurgitation, (TR).  The TR jet in this view is eyeballed at mild to moderate in severity.

Parasternal short axis at the level of the LVOT showing the anterior mitral valve leaflet.  The  dilated RV is seen to flatten the interventricular septum throughout the cardiac cycle.  There is a small pericardial effusion.

Parasternal short axis at the level of the mitral valve changing towards PLAX as the patient breaths.  The severely dilated RV is seen to flatten the interventricular septum throughout the cardiac cycle.

Apical 4-chamber view showing the severely dilated RV.  The RV apex has taken over the cardiac apex and displaced the LV apex more basally. The RV is heavily trabeculated.  Both atria are dilated.

Apical 4-chamber view with colour across the mitral valve showing a more anteriorly directed jet of MR.  Note the motion of the interventricular septum, (IVS).

Apical 4-chamber view with colour across the tricuspid valve showing a moderate jet of TR.

 

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CW Doppler spectral trace of the TR jet.  The angle of incidence is parallel to the flow giving the most accurate estimation of the velocity.  There is considerable respiratory variation.  If time allows, measure several beats and average them.

Apical long axis of the left ventricle, (also named Apical 3-chamber view) with colour across the mitral leaflet demonstrating moderate MR.

Subcostal view of the long axis of the IVC entering the RA.  A portion of the “Eustachian valve” can again be seen. ( It is the embryological remnant.  A normal variant).  There is a small amount of free fluid in the anterior of the flield of view.  It appears to be extra pericardial, possibly ascities.

Longitudinal view of the diaphragm, demonstrating a large right pleural effusion.

Longitudinal view above the diaphragm demonstrating collapsed lung with air broncogram.  The spinal artifact can be well seen extending above the diaphragm.

Longitudinal R3 lung zone, again showing right pleural effusion with aerated lung seen.

 

 

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