Anatomy, Function, and Dysfunction of the Right Ventricle

In this state-of-the-art review review, the authors summarize current knowledge of anatomic, structural, metabolic, functional, and hemodynamic characteristics of the right ventricle (RV) in both health and disease. Highlights of this review are:

• Anatomically and functionally different from the left ventricle, the RV plays an increasingly recognized role in determining both 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. These 3 situations have distinct clinical course and therapeutic approach although they commonly coexist in various degrees.
• Advances promise to enhance our understanding of the mechanisms of RV adaptation or maladaptation to pathologic conditions. These include refinements in the evaluation of RV anatomy, myoarchitecture, ultrastructure, metabolism, perfusion, function, and degree of coupling to the pulmonary circulation. Such evaluation can be performed invasively but increasingly is accomplished through noninvasive imaging.