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Education in Heart
Non-invasive imaging
The right ventricle: anatomy, physiology and clinical imaging
  1. Florence Sheehan1,
  2. Andrew Redington2
  1. 1
    Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
  2. 2
    Hospital for Sick Children, Toronto, Ontario, Canada
  1. Dr Florence Sheehan, University of Washington Box 356422, Seattle, WA 98195-6422, USA; sheehan{at}u.washington.edu

https://doi.org/10.1136/hrt.2007.132779

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    Not long ago the right ventricle (RV) was considered an “unnecessary” part of the normal circulation. While factually correct—ablation or replacement of the RV free wall can be well tolerated by experimental animals without reduction in cardiac output, and many surgical algorithms for congenital heart diseases culminate in a circulation devoid of a sub-pulmonary ventricle, a Fontan procedure, for example—it is clear that such circulations are far from normal. Furthermore, recent studies consistently demonstrate a central role for RV dysfunction in the prognosis and outcomes for a wide variety of acquired and congenital cardiac conditions. Consequently there has been a renewed interest in the singular role of the RV, as well as its influence on global function via biventricular interactions. In this review, we will discuss some of the challenges encountered in the measurement of RV volume and function in the context of the RV’s unique anatomic structure and physiology.

    ANATOMIC CONSIDERATIONS

    The role of both ventricles is to propel blood forward in the circulation. To enable this mechanical role, ventricular function is intimately related to ventricular structure. However, the two ventricles differ. Morphologically, the RV is distinguished from the left ventricle (LV) by having coarser trabeculae, a moderator band, and a lack of fibrous continuity between its inlet and outflow valves. In the RV the pulmonary valve sits on a freestanding muscular infundibulum and the crista supraventricularis courses between it and the tricuspid valve to aid free wall contraction toward the interventricular septum. Because it normally operates at a lower pressure than the LV, the RV has a thinner wall. Its septal contour is indented by the dominant LV, producing a shape that is difficult to model geometrically (fig 1).

    Figure 1 Three dimensional reconstructions of the right ventricle (RV) illustrating its complex shape in a normal subject (A). RV remodelling in diseased hearts can result in profound shape change, as in this patient (B) with dilated RV due to severe pulmonary regurgitation following repair of tetralogy of Fallot. The mesh surface is the left ventricle. LV, left ventricle; P, pulmonary valve; RV, right ventricle; T, tricuspid valve. See Sheehan and Bolson14 for explanation of reconstruction method.

    Nearly all studies of ventricular fibre structure were performed on the LV.1 Dissection studies showed that its fibres course …

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    Footnotes

    • Competing interests: In compliance with EBAC/EACCME guidelines, all authors participating in Education in Heart have disclosed potential conflicts of interest that might cause a bias in the article. In accordance with instructions from her oversight committee at the University of Washington, Florence Sheehan wishes to notify you that she is a founder and equity holder of VentriPoint Diagnostics, Inc. She has received research grants from this company. Andrew Redington has no competing interest to report.