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Journal of the American College of... Apr 2019There 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... (Review)
Review
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.
Topics: Heart Ventricles; Hemodynamics; Humans; Hypertension, Pulmonary; Ventricular Dysfunction, Right; Ventricular Function, Right
PubMed: 30922478
DOI: 10.1016/j.jacc.2018.12.076 -
Critical Care (London, England) Sep 2016The primary role of the right ventricle (RV) is to deliver all the blood it receives per beat into the pulmonary circulation without causing right atrial pressure to... (Review)
Review
The primary role of the right ventricle (RV) is to deliver all the blood it receives per beat into the pulmonary circulation without causing right atrial pressure to rise. To the extent that it also does not impede left ventricular (LV) filling, cardiac output responsiveness to increased metabolic demand is optimized. Since cardiac output is a function of metabolic demand of the body, during stress and exercise states the flow to the RV can vary widely. Also, instantaneous venous return varies widely for a constant cardiac output as ventilatory efforts alter the dynamic pressure gradient for venous return. Normally, blood flow varies with minimal changes in pulmonary arterial pressure. Similarly, RV filling normally occurs with minimal increases in right atrial pressure. When pulmonary vascular reserve is compromised RV ejection may also be compromised, increasing right atrial pressure and limiting maximal cardiac output. Acute increases in RV outflow resistance, as may occur with acute pulmonary embolism, will cause acute RV dilation and, by ventricular interdependence, markedly decreased LV diastolic compliance, rapidly spiraling to acute cardiogenic shock and death. Treatments include reversing the causes of pulmonary hypertension and sustaining mean arterial pressure higher than pulmonary artery pressure to maximal RV coronary blood flow. Chronic pulmonary hypertension induces progressive RV hypertrophy to match RV contractility to the increased pulmonary arterial elastance. Once fully developed, RV hypertrophy is associated with a sustained increase in right atrial pressure, impaired LV filling, and decreased exercise tolerance. Treatment focuses on pharmacologic therapies to selectively reduce pulmonary vasomotor tone and diuretics to minimize excessive RV dilation. Owning to the irreversible nature of most forms of pulmonary hypertension, when the pulmonary arterial elastance greatly exceeds the adaptive increase in RV systolic elastance, due to RV dilation, progressive pulmonary vascular obliteration, or both, end stage cor pulmonale ensues. If associated with cardiogenic shock, it can effectively be treated only by artificial ventricular support or lung transplantation. Knowing how the RV adapts to these stresses, its sign posts, and treatment options will greatly improve the bedside clinician's ability to diagnose and treat RV dysfunction.
Topics: Cardiac Output; Heart Ventricles; Humans; Hypertension, Pulmonary; Pulmonary Circulation; Ventricular Dysfunction, Right
PubMed: 27613549
DOI: 10.1186/s13054-016-1440-0 -
Anesthesiology Jan 2019
Review
Topics: Echocardiography; Heart Defects, Congenital; Heart Ventricles; Humans
PubMed: 30192239
DOI: 10.1097/ALN.0000000000002438 -
Cardiology Clinics May 2020Right heart failure is a major cause of morbidity and mortality in pulmonary hypertension. Its pathophysiology is complex and involves both adaptive and maladaptive... (Review)
Review
Right heart failure is a major cause of morbidity and mortality in pulmonary hypertension. Its pathophysiology is complex and involves both adaptive and maladaptive patterns of right ventricular change. In addition to the gold standard of right heart catheterization, noninvasive imaging such as echocardiography is useful in diagnosis and risk assessment. Management focuses on optimizing preload, reducing afterload, and supporting the function of the right ventricle with vasopressors and inotropes, if necessary. If required, mechanical support is increasingly used to facilitate recovery or as a bridge to transplant.
Topics: Cardiac Catheterization; Echocardiography; Heart Failure; Heart Ventricles; Humans; Hypertension, Pulmonary; Ventricular Function, Right
PubMed: 32284101
DOI: 10.1016/j.ccl.2020.02.001 -
Journal of Anatomy Jan 2023The right ventricle (RV) is an important structure which serves a multitude of vital physiological functions in health. For many years, the left ventricle has dominated... (Review)
Review
The right ventricle (RV) is an important structure which serves a multitude of vital physiological functions in health. For many years, the left ventricle has dominated the focus of understanding in both biology and pathophysiology and the RV was felt to be more of a passive structure which rarely had an effect on disease states. However, it is increasingly recognised that the RV is essential to the homoeostasis of normal physiology and disturbances in RV structure and function have a substantial effect on patient outcomes. Indeed, the prognosis of diseases of lung diseases affecting the pulmonary vasculature and left heart disease is intimately linked to the function of the right ventricle. This review sets out to describe the developmental and anatomical complexities of the right ventricle while exploring the modern techniques employed to image and understand its function from a clinical perspective.
Topics: Humans; Heart Ventricles
PubMed: 35285014
DOI: 10.1111/joa.13654 -
Postgraduate Medical Journal Aug 2020Anatomical complexities coupled with a protracted subclinical disease course, particularly in the early stages, makes the right ventricle (RV) the less studied entity... (Review)
Review
Anatomical complexities coupled with a protracted subclinical disease course, particularly in the early stages, makes the right ventricle (RV) the less studied entity when compared with the left. RV failure is an important predictor of survival in patients with cardiovascular disease. Technological advances have made it possible to visualise and characterise a variety of diseases that affect the RV. This review article will give a broad overview of the main RV pathology to general radiologists in particular those that manifest in adulthood. Congenital heart disease is a vast topic that is beyond the scope of this paper.
Topics: Adult; Heart Ventricles; Humans; Magnetic Resonance Imaging; Tomography, X-Ray Computed; Ventricular Dysfunction, Right; Ventricular Function, Right
PubMed: 32184259
DOI: 10.1136/postgradmedj-2019-137220 -
The Heart Surgery Forum Aug 2021Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease, and its main characteristic is symmetrical or asymmetrical hypertrophy of the left... (Review)
Review
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease, and its main characteristic is symmetrical or asymmetrical hypertrophy of the left ventricle and/or right ventricle. Most previous studies mainly include the left ventricle for definition of HCM, thus neglecting the right ventricle. But recently, many studies have reported the right ventricular involvement in HCM. Histopathological results showed that similar pathogenic changes in both the right and left ventricles, which suggests common myopathic processes and sarcomere genetic mutations. Cardiovascular magnetic resonance (CMR) is a gold standard imaging modality to assess heart anatomy and function and provides highly accurate and reproducible measurements. CMR is very useful in characterizing the various phenotypes of right and left ventricles in HCM. CMR also can be useful in detecting early and dominant phenotypic expression of HCM. Due to the complex geometry of the right ventricle and its retrosternal position, echocardiography may not provide accurate measurements. CMR also provides more accurate and repeatable right ventricular measurements. Thus, right ventricle evaluation along with left ventricle should routinely be done for better assessment of HCM patients.
Topics: Cardiomyopathy, Hypertrophic; Heart Ventricles; Humans; Magnetic Resonance Imaging; Ventricular Dysfunction, Right
PubMed: 34473022
DOI: 10.1532/hsf.3977 -
Journal of the American Heart... Apr 2024
Topics: Humans; Prognosis; Heart Ventricles; Hypertension, Pulmonary; Ventricular Function, Right; Patients
PubMed: 38567674
DOI: 10.1161/JAHA.124.034711 -
Circulation. Cardiovascular Imaging Mar 2018The right ventricle has frequently been described as the forgotten ventricle in the circulation. However, its importance both in acquired and congenital heart disease is... (Review)
Review
The right ventricle has frequently been described as the forgotten ventricle in the circulation. However, its importance both in acquired and congenital heart disease is now unquestioned. This recognition has led to improved risk stratification and development of algorithms for intervention, which incorporate measurements of right ventricular function as key components of the assessment of many conditions. Indeed, such has been the emphasis on characterizing right ventricular dysfunction; the contribution of left ventricular dysfunction to the outcomes of diseases traditionally thought of as right sided has perhaps been underappreciated. In this review, we remind ourselves of the biventricular nature of almost all cardiovascular diseases and, in particular, how the left ventricle can both be a culprit in causation of, and a potential therapeutic target for, late morbidity and mortality in congenital heart disease.
Topics: Echocardiography; Heart Defects, Congenital; Heart Ventricles; Humans; Ventricular Function, Left; Ventricular Function, Right
PubMed: 29855426
DOI: 10.1161/CIRCIMAGING.117.007410 -
Journal of the American College of... Feb 2022
Topics: Cardiac Surgical Procedures; Heart Ventricles; Humans; Pulmonary Artery; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 35115102
DOI: 10.1016/j.jacc.2021.11.030