Right Ventricular Volume Determination By Two-Dimensional Echocardiography And Radiography In Model Hearts Using A Subtraction Method

The irregularity and complexity of the right ventricle is the reason why no accurate method for right ventricular volume determination exists. A new method for right ventricular volume determination particularly for two-dimensional echocardiography was developed-it is called subtraction method-and was compared with the pyramid and Simpson's methods. The partial volume of the left ventricle and septum was subtracted from total volume of right and left ventricle including interventricular septum. Thus right ventricular volume resulted. Total and partial volume were computer-assisted calculated by use of biplane methods, preferably Simpson's rule. The method was proved with thinwall silicon-rubber model hearts of the left and right ventricle. Two orthogonal planes in the long-axis were filmed by radiography or scanned in a water bath by two-dimensional echocardiography equivalent to RAO and LAO-projections of cineangiocardiograms or to four- and two-chamber views of apical two-dimensional echocardiograms. For calculation of the major axes of the elliptical sections, summed up by Simpson's rule, they were derived from the LAO-projection and the four-chamber view, respectively, the minor axis approximated from the RAO-projection and the two-chamber view. For comparison of direct-measured volume and two-dimensional echocardiographically determined volume, regression equation was given by y = 1.01 x -3.2, correlation-coefficient, r = 0.977, and standard error of estimate (SEE) +/- 10.5 ml. For radiography, regression equation was y = 0.909 x + 13.3,r = 0.983, SEE = +/- 8.0 ml. For pyramid method and Simpson's rule, higher standard errors and lower correlation coefficients were found. Between radiography and two-dimensional echocardiography a mean difference of 4.3 +/- 13.2 ml, using subtraction method, and -10.2 +/- 22.9 ml, using pyramid method, as well as -0,6 +/- 18.5 ml, using Simpson's rule, were calculated for right ventricular volume measurements. Differences were not significant. The subtraction method seems to be useful for calculation of right ventricular volume by radiography as well as two-dimensional echocardiography. Further studies in isolated hearts and patients are necessary for final judgment of the accuracy of this new method.