Two-dimensional echocardiography in arrhythmogenic right ventricular dysplasia

Comparison of two-dimensional echocardiography and right ventricular angiographic findings was carried out in patients with arrhythmogenic right ventricular dysplasia. Diagnosis was based on ECG and angiographic criteria in all cases. Echo and angiographic findings corresponded closely when diffuse enlargement and hypokinesis of the right ventricle were present. Echo evidence of localized disease, manifest by bulges or sacculations of the right ventricle, predicted the presence of similar lesions by angiography, but agreement as to specific lesion location was poor. In a review of over 9000 consecutive echocardiograms, right ventricular abnormalities were detected in 18% with only two patients having documented right ventricular dysplasia. In the patient with suspected arrhythmogenic right ventricular dysplasia, two-dimensional echo evidence of diffuse right ventricular enlargement, which is otherwise unexplained, strongly supports the diagnosis and angiography may be avoided. Local changes seen by echo should increase suspicion of right ventricular dysplasia in patients with relevant clinical findings. The detection of any right ventricular abnormality, without coexisting clinical findings is not enough to assign the diagnosis of right ventricular dysplasia since there are so many other disorders that alter right ventricular morphology.