Anatomy, Function, and Dysfunction of the Right Ventricle

• Published in: Journal of the American College of Cardiology Vol. 73; no. 12; pp. 1463 - 1482
• Main Authors: Sanz, Javier, Sánchez-Quintana, Damián, Bossone, Eduardo, Bogaard, Harm J., Naeije, Robert
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2019
• Subjects: pulmonary hypertension; right ventricle; right ventricular function; EF; SV; RV; pulmonary hypertension; ESV; LV; right ventricular function; PA; Ees; right ventricle; EDV; PH; Ea
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2018.12.076

There is increasing recognition of the crucial role of the right ventricle (RV) in determining functional status and prognosis in multiple conditions. The normal RV is anatomically and functionally different from the left ventricle, which precludes direct extrapolation of our knowledge of left-sided physiopathology to the right heart. RV adaptation is largely determined by the level of exposure to hemodynamic overload (both preload and afterload) as well as its intrinsic contractile function. These 3 processes (pressure overload, volume overload, and RV cardiomyopathy) are associated with distinct clinical course and therapeutic approach, although in reality they often coexist in various degrees. The close relationship between the RV and left ventricle (ventricular interdependence) and its coupling to the pulmonary circulation further modulate RV behavior in different clinical scenarios. In this review, the authors summarize current knowledge of RV anatomic, structural, metabolic, functional, and hemodynamic characteristics in both health and disease. [Display omitted] •Anatomically and functionally different from the left ventricle, the RV plays an increasingly recognized role in determining symptoms and outcomes in multiple conditions.•The normal RV is coupled to the low-pressure, high-compliance pulmonary circulation to ensure transfer of blood to the pulmonary arteries in an energy efficient fashion. RV adaptation to disease is determined by the degree of pressure overload, volume overload, and alterations in intrinsic contractility, 3 situations with distinct clinical course and therapeutic approach although commonly coexisting in various degrees.•Refinements in the evaluation of RV anatomy, myoarchitecture, ultrastructure, metabolism, perfusion, and function, and of its degree of coupling (or lack thereof) to the pulmonary circulation, either invasively or increasingly through noninvasive imaging, promise to enhance our understanding of the mechanisms of RV adaptation or maladaptation to pathologic conditions.