Interpreting The Sub Xiphoid View

In this view the right ventricle (RV) is seen as the closest chamber through the window of the left lobe of the liver. Beyond is the left ventricle (LV) and more distant are both atria.

This view is excellent for pulse check imaging as it shows global motility, the possibility of a pericardial effusion, the RV/LV ratio and basic LV function.

The end-systolic RV/LV ratio should be around 0.5, with the LV indenting the RV into a bean shape, or a letter D . If this D is reversed with the RV indenting the LV it is strongly indicative of high right sided pressures. In the acute setting this may suggest pulmonary embolus. In this case it is important to quickly look at the IVC for signs of distension. RV/LV ratios > 1 are associated with adverse clinical outcomes.

RV/LV ratios in healthy controls in one study revealed a mean of 0.51 (95% confidence interval, 0.48-0.54). Meanwhile those with known pulmonary hypertension had ratios of 1.47 (mean, 95% confidence interval, 1.25-1.70). The RV/LV ratio correlated significantly with pulmonary artery pressure.

Learning bite

The rv/lv ratio correlates with pulmonary artery pressure and the normal should be around 0.5. Ratios above 1 are associated with adverse clinical outcomes.