[M- and real-time b-scan diagnostic criteria and pit-falls in right ventricular volume overload (author's transl)]

The observation of a characteristic "see-saw" motion of the interventricular septum (IVS) in real-time B-scan (RTBS) in right ventricular volume overload (RVVO) reveals features which have not been taken into account in diagnostic M-scan echocardiography. From an investigation of 20 patients it became apparent that the criteria (1) increase in right ventricular internal diameter and (2) "paradoxical" septal motion, so far used for the M-scan diagnosis of RVVO, should be complemented by further criteria: (3) hypertrophy of the IVS in longstanding RVVO, (4) increase in septal amplitude of motion towards the cardiac apex, (5) selective increasing apical septal hypertrophy and (6) an apparent random septal motion without any resultant main direction as an indication of a displaced fulcrum of the septal "see-saw". All features may be visualised by carrying out a continuous sweep in M-scanning. The criteria 2-5 may be understood as a result of increased apical work load compensating for the haemodynamic loss of the reversed upper septal motion ("RUSM"). The diagnosis of RVVO can be made more readily and reliably with RTBS echocardiography, underlining the utility of a combined use of one- and two-dimensional ultrasonography in diagnostic cardiology.