Echocardiographic Assessment: Apical 4 Chamber

• Right atrial size (often dilated in setting of anomalous venous return)
• Right ventricular size and function (often dilated and hypertrophied)
• Left atrial size (often small and underfilled)
• Left ventricular size (often small and underfilled)
• Pulmonary hypertension assessment (tricuspid regurgitation by color and spectral Doppler)
• Pulmonary venous confluence (posterior to left atrium)
• Venous drainage into pulmonary venous confluence 
  • Assess individual veins (by 2D, color and spectral Doppler)