Chapter 19. Right Ventricular Cardiomyopathies

Representative cardiac magnetic resonance (CMR) white blood images. The normal right ventricle (RV) is crescent shaped when viewed axially (A), triangular (curved) when viewed sagittally (B and C), and similar to a teapot when viewed coronally (D).

A. Cardiac magnetic resonance imaging white blood (steady-state free precession) cine image. The right ventricular (RV) apex is entirely separate and independent from the left ventricular (LV) apex ("butterfly" apex; black arrow). Left. Diastole. Right. Systole. Note the thin hypokinetic RV apex in this normal patient (white arrow). B. Importance of foreshortening. This is a normal volunteer without heart disease. Note the left panel images (a = diastole; b = systole) that were obtained within minutes of the right panel images (c = diastole; d = systole). The image on the left was obtained with a slightly inferior angulation relative to the truly aligned four-chamber view on the right creating a foreshortened LV long axis diameter (dotted lines equal length). Due to the pyramidal RV shape, this inferior angulation creates an elongated RV cavity relative to the LV. This creates a falsely dilated RV cavity and also accentuates the RV apex, which appears separated from the LV ("butterfly") and hypokinetic (arrows). See Moving Image 19–2B.