Review

Authors: Javier Sanz, Damián Sánchez-Quintana, Eduardo Bossone...

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

Review

Authors: Sanjiv Gupta, Madan Mohan Gupta

Takotsubo syndrome is a reversible acute heart failure frequently precipitated by an emotional or physical stress. The clinical presentation resembles acute coronary syndrome. Pathogenesis is complex and may involve brain-heart axis and neuro-hormonal stunning of the myocardium. Coronary angiography reveals normal epicardial arteries with no obstruction or spasm. NT-ProBNP maybe remarkably elevated. Regional wall motion akinesia (RWMA) of left ventricle extends beyond the territory of one coronary artery. Reduced left ventricle ejection fraction (LVEF) and RWMA recover in 6-12 weeks. Prognosis is generally good. Recent meta-analysis shows in-hospital mortality of 1-4.5% and recurrence rate of 5-10% during five year follow-up.

Topics: Coronary Angiography; Electrocardiography; Heart Ventricles; Humans; Takotsubo Cardiomyopathy; Ventricular Function, Left

PubMed: 29455773
DOI: 10.1016/j.ihj.2017.09.005

Review

Authors: Michael R Pinsky

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

Authors: Robert Zilberszac

Sonography, in particular echocardiography, is essential in the assessment of volume status and hemodynamics in critically ill patients. Examination of the left ventricle, in addition to assessing ventricular function, provides valuable information, including the "kissing papillary muscle sign," which may indicate fluid responsiveness. Examination of the right ventricle is also important because it is sensitive to both volume and pressure overload. Assessment of diastolic function and measurement of inferior vena cava width and variability provide clues to left and right ventricular preload, respectively. Measurement of stroke volume and cardiac output allows further assessment of hemodynamics and also permits determination of stroke volume variability.

Topics: Humans; Cardiac Output; Critical Care; Echocardiography; Heart Ventricles; Hemodynamics; Papillary Muscles; Point-of-Care Testing; Stroke Volume; Vena Cava, Inferior

PubMed: 39384618
DOI: 10.1007/s00063-024-01191-3

Authors: Frances S de Man, Anton Vonk Noordegraaf

Topics: Humans; Heart Ventricles; Pulmonary Arterial Hypertension; Echocardiography; Diastole; Familial Primary Pulmonary Hypertension; Ventricular Function, Right

PubMed: 37208035
DOI: 10.1183/13993003.00509-2023

Review

Authors: Harrison Stubbs, Alexander MacLellan, Stephanie Lua...

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

Authors: Adam L Dorfman, Pedro J Del Nido

Topics: Fontan Procedure; Heart Ventricles; Humans; Treatment Outcome; Tricuspid Valve; Tricuspid Valve Insufficiency

PubMed: 35331852
DOI: 10.1016/j.jacc.2022.03.003

Authors: Ambreen F Ali, Rhonda Miyasaka, Christine L Jellis...

Topics: Humans; Prognosis; Heart Ventricles; Hypertension, Pulmonary; Ventricular Function, Right; Patients

PubMed: 38567674
DOI: 10.1161/JAHA.124.034711

Authors: Richard J Czosek, Jeffrey B Anderson, Shankar Baskar...

BACKGROUND

Mortality in cohorts with a single ventricle remains high with multiple associated factors. The effect of heart block during stage I palliation remains unclear.

OBJECTIVE

The purpose of this study was to study patient and surgical risks of heart block and its effect on 12-month transplant-free survival in patients with a single ventricle.

METHODS

Patient, surgical, outcome data and heart block status (transient and permanent) were obtained from the National Pediatric Cardiology Quality Improvement Collaborative single ventricle database. Bivariate analysis was performed comparing patients with and without heart block, and multivariate modeling was used to identify variables associated with block. One-year outcomes were analyzed to identify variables associated with lower 12-month transplant-free survival.

RESULTS

In total, 1423 patients were identified, of whom 28 (2%) developed heart block (second degree or complete) during their surgical admission. Associated risk factors for block included heterotaxy syndrome (odds ratio [OR] 6.4) and atrial flutter/fibrillation (OR 3.8). Patients with heart block had lower 12-month survival, though only in patients with complete heart block as opposed to second degree block. At 12 months of age, 43% (12/28) of patients with heart block died and were more likely to experience mortality at 12 months than patients without block (OR 4.9; 95% confidence interval 1.4-17.5; P = .01).

CONCLUSION

Although rare, complete heart block after stage I palliation represents an additional risk of poor outcomes in this high-risk patient population. Heterotaxy syndrome was the most significant risk factor for the development of heart block after stage I palliation. The role of transient block in outcomes and potential rescue with long-term pacing remains unknown and requires additional study.

Topics: Adolescent; Child; Heart Block; Heart Ventricles; Humans; Male; Palliative Care; Postoperative Complications; Risk Assessment; Risk Factors

PubMed: 34029735
DOI: 10.1016/j.hrthm.2021.05.019

Authors: Christoph P Hornik

Topics: Heart Defects, Congenital; Heart Ventricles; Humans; Univentricular Heart

PubMed: 33812687
DOI: 10.1016/j.jtcvs.2021.03.023