Three-Dimensional Echocardiographic Evaluation of the Right Ventricle in Normal Egyptian Children

Document Type : Original Article


Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.


Background: The right ventricle (RV) is a major determinant of clinical outcomes in different cardiopulmonary disorders. Quantification of the RV with 2D echocardiography is challenging because of its complex asymmetrical geometry.1,2 Three-dimensional echocardiography is becoming more prevalent in children because of good acoustic windows and the noninvasive nature of the technique. Three-dimensional echocardiography allows the measurement of RV volumes, thereby overcoming the limitations of 2D echocardiography.3
Methods: A prospective observational cross-sectional study was performed on 450 normal Egyptian children randomly chosen including both sexes. The subjects were divided into 2 age groups. ECG-gated 2D and 3D transthoracic echocardiography was done to evaluate RV parameters.
Results: The feasibility of 3D echocardiography was 96%. Mean indexed RVEDV was 40.5±5.4 mL/m2 in boys and 40.1±5.8 mL/m2 in girls, mean indexed RVESV was 18.8±3.7 mL/m2 in boys and 18.7±3.7 mL/m2 in girls, mean indexed stroke volume was 21.6±3.1 mL/m2 in boys and 21.3±3.6 mL/m2 in girls, and mean RVEF was 53.7±5.1% in boys and 53.5±5.4% in girls. A significant negative correlation existed between 3DE RVEF and ESV. A strong positive correlation was observed between mean 3DE RVESV and mean 3DE RVEDV. Further, 2DE and 3DE RVESV and EDV mean indexed and absolute values showed significant differences. Additionally, 2DE and 3DE FAC mean values showed positive significant correlations, and 3DE FAC and RVEF showed modest positive correlations.
Conclusions: Three-dimensional echocardiography provides RV volume quantification and functional assessment without any geometric assumptions. Reference values and percentile curves were established for RV parameters by 3DE for the first time in the Egyptian children population. (Iranian Heart Journal 2022; 23(2): 42-52)


  1. Tamborini G, Marsan NA, Gripari P, Maffessanti F, Brusoni D, Muratori M, et al. Reference values for right ventricular volumes and ejection fraction with real-time three-dimensional echocardiography: evaluation in a large series of normal subjects. Journal of the American Society of Echocardiography. 2010; 23(2):109-15.
  2. Ho S, Nihoyannopoulos P. Anatomy, echocardiography, and normal right ventricular dimensions. Heart. 2006; 92(suppl 1):i2-i13.
  3. Surkova E, Muraru D, Iliceto S, Badano LP. The use of multimodality cardiovascular imaging to assess right ventricular size and function. International journal of cardiology. 2016; 214:54-69.
  4. Grewal J, Majdalany D, Syed I, Pellikka P, Warnes CA. Three-dimensional echocardiographic assessment of right ventricular volume and function in adult patients with congenital heart disease: comparison with magnetic resonance imaging. Journal of the American Society of Echocardiography. 2010; 23(2):127-33.
  5. Anderson RH, Becker AE, Freedom RM, Macartney FJ, Quero-Jimenez M, Shinebourne EA, et al. Sequential segmental analysis of congenital heart disease. Pediatric cardiology. 1984; 5(4):281-7.
  6. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography: endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. Journal of the American society of echocardiography. 2010; 23(7):685-713.
  7. Lu X, Nadvoretskiy V, Bu L, Stolpen A, Ayres N, Pignatelli RH, et al. Accuracy and reproducibility of real-time three-dimensional echocardiography for assessment of right ventricular volumes and ejection fraction in children. Journal of the American Society of Echocardiography. 2008; 21(1):84-9.
  8. De Potter T, Weytjens C, Motoc A, Luchian ML, Scheirlynck E, Roosens B, et al. Feasibility, Reproducibility and Validation of Right Ventricular Volume and Function Assessment Using Three-Dimensional Echocardiography. Diagnostics. 2021; 11(4):699.
  9. Federico Veronesi GRL, Stein Inge Rabben, Jørn Bersvendsen, Healthcare G. 4D Auto RVQ (Right Ventricle Quantification). In: Healthcare G, editor.: GE Healthcare; 2017.
  10. Bonnet S, Provencher S, Guignabert C, Perros F, Boucherat O, Schermuly RT, et al. Translating research into improved patient care in pulmonary arterial hypertension. American journal of respiratory and critical care medicine. 2017; 195(5):583-95.
  11. Horton KD, Meece RW, Hill JC. Assessment of the right ventricle by echocardiography: a primer for cardiac sonographers. Journal of the American society of echocardiography. 2009; 22(7):776-92.
  12. Séguéla PE, Hascoët S, Brierre G, Bongard V, Acar P. Feasibility of three‐dimensional transthoracic echocardiography to evaluate right ventricular volumes in children and comparison to left ventricular values. Echocardiography. 2012;29(4):492-501.
  14. Laser KT, Karabiyik A, Körperich H, Horst J-P, Barth P, Kececioglu D, et al. Validation and reference values for three-dimensional echocardiographic right ventricular volumetry in children: a multicenter study. Journal of the American Society of Echocardiography. 2018; 31(9):1050-63.
  15. Herberg U, Smit F, Winkler C, Dalla-Pozza R, Breuer J, Laser KT. Real-time 3D-echocardiography of the right ventricle—paediatric reference values for right ventricular volumes using knowledge-based reconstruction: a multicentre study. Quantitative Imaging in Medicine and Surgery. 2021; 11(7):2905-17.
  16. Papavassiliou DP, Parks WJ, Hopkins KL, Fyfe DA. Three-dimensional echocardiographic measurement of right ventricular volume in children with congenital heart disease validated by magnetic resonance imaging. Journal of the American Society of Echocardiography. 1998; 11(8):770-7.
  17. Srinivasan C, Sachdeva R, Morrow WR, Greenberg SB, Vyas HV. Limitations of standard echocardiographic methods for quantification of right ventricular size and function in children and young adults. Journal of Ultrasound in Medicine. 2011; 30(4):487-93.
  18. Kovalova S, Necas J, Vespalec J. What is a “normal” right ventricle? European Journal of Echocardiography. 2006;7(4):293-7.
  19. Evaldsson AW, Lindholm A, Jumatate R, Ingvarsson A, Smith GJ, Waktare J, et al. Right ventricular function parameters in pulmonary hypertension: echocardiography vs. cardiac magnetic resonance. BMC Cardiovascular Disorders. 2020;20:1-12.
  20. Hamilton-Craig CR, Stedman K, Maxwell R, Anderson B, Stanton T, Chan J, et al. Accuracy of quantitative echocardiographic measures of right ventricular function as compared to cardiovascular magnetic resonance. IJC Heart & Vasculature. 2016;12:38-44.