Anatomy, Function, and Dysfunction of the Right Ventricle: JACC State-of-the-Art Review

Highlights •Anatomically and functionally different from the left ventricle, the RV plays an increasingly recognized role in determining 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, 3 situations with distinct clinical course and therapeutic approach although commonly coexisting in various degrees. •Refinements in the evaluation of RV anatomy, myoarchitecture, ultrastructure, metabolism, perfusion, and function, and of its degree of coupling (or lack thereof) to the pulmonary circulation, either invasively or increasingly through noninvasive imaging, promise to enhance our understanding of the mechanisms of RV adaptation or maladaptation to pathologic conditions.