Right Ventricular Function in Cardiovascular Disease, Part I Anatomy, Physiology, Aging, and Functional Assessment of the Right Ventricle
TLDR
The goal of the present review is to offer a clinical perspective on RV structure and function, using echocardiography and magnetic resonance imaging to create new opportunities for the study of RV anatomy and physiology.Abstract:
In 1616, Sir William Harvey was the first to describe the importance of right ventricular (RV) function in his seminal treatise, De Motu Cordis : “Thus the right ventricle may be said to be made for the sake of transmitting blood through the lungs, not for nourishing them.”1,2 For many years that followed, emphasis in cardiology was placed on left ventricular (LV) physiology, overshadowing the study of the RV. In the first half of the 20th century, the study of RV function was limited to a small group of investigators who were intrigued by the hypothesis that human circulation could function adequately without RV contractile function.3 Their studies, however, were based on an open pericardial dog model, which failed to take into account the complex nature of ventricular interaction. In the early 1950s through the 1970s, cardiac surgeons recognized the importance of right-sided function as they evaluated procedures to palliate right-heart hypoplasia. Since then, the importance of RV function has been recognized in heart failure, RV myocardial infarction, congenital heart disease and pulmonary hypertension. More recently, advances in echocardiography and magnetic resonance imaging have created new opportunities for the study of RV anatomy and physiology.
The goal of the present review is to offer a clinical perspective on RV structure and function. In the first part, we discuss the anatomy, physiology, aging, and assessment of the RV. In the second part, we discuss the pathophysiology, clinical importance, and management of RV failure.
### Macroscopic Anatomy of the RV
In the normal heart, the RV is the most anteriorly situated cardiac chamber and lies immediately behind the sternum. In the absence of transposition of great arteries, the RV is delimited by the annulus of the tricuspid valve and by the pulmonary valve. As suggested by Goor and Lillehi,4 the RV can be described in …read more
Citations
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The right ventricle in health and disease: insights into physiology, pathophysiology and diagnostic management.
TL;DR: The hemodynamic conditions and cellular and biochemical pathways that lead to right heart failure are presented and the imaging modalities that aid in the assessment of RV structure and function are described and the importance of the diagnostic and prognostic information they provide is discussed.
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Application of 3-dimensional speckle tracking imaging to the assessment of right ventricular regional deformation.
Akiko Atsumi,Tomoko Ishizu,Yuri Kameda,Masayoshi Yamamoto,Yoshie Harimura,Tomoko Machino-Ohtsuka,Ryo Kawamura,Mami Enomoto,Yoshihiro Seo,Kazutaka Aonuma +9 more
TL;DR: 3DSTI indicated segmental heterogeneity in magnitude and timing of RV contraction in patients with RV dysfunction and may be a promising modality for providing precise quantitative information on complex RV wall motion.
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Quantification of left and right atrial kinetic energy using four-dimensional intracardiac magnetic resonance imaging flow measurements.
TL;DR: Kinetic energy of atrial blood generated during ventricular systole may be conserved in a hydraulic "flywheel" and transferred to the RV through helical flow, which may contribute to RV filling, and right ventricle relaxation does not seem to contribute to atrial KE.
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All you need to know about the tricuspid valve: Tricuspid valve imaging and tricuspid regurgitation analysis
Olivier Huttin,Damien Voilliot,Damien Mandry,Clément Venner,Yves Juillière,Christine Selton-Suty +5 more
TL;DR: A better description of TV anatomy and function by multimodality imaging should help with the appropriate selection of patients who will benefit from either surgical TV repair/replacement or a percutaneous procedure for TR, especially among patients who are to undergo or have undergone primary left-sided valvular surgery.
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Pulmonary Hypertension and Right Ventricular Failure in Emergency Medicine
TL;DR: Emergency physicians should appreciate the role of pulmonary vasodilators in the treatment of pulmonary arterial hypertension and recognize that patients receiving these medications may rapidly develop right ventricular failure and even death without these therapies.
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