Dr. Jan Marek,
This symposium provided an outstanding review of our current understanding of right ventricular mechanics, including information on practical assessment and the impact on clinical practice in both congenital heart disease and pulmonary hypertension.
Beginning with a complete overview of the embryologic and myocardial architectural differences between the right and left ventricles, the session progressed to a discussion on how the right ventricle adapts to variable loading conditions. Techniques for assessing right ventricular adaptation were presented, including routine echocardiographic indices such as M-mode evaluation of ventricular septal motion, advanced speckle tracking techniques, and cardiac MRI.
These techniques provided the background to evaluate the right ventricular response to pulmonary valve implantation and to understand the subtle differences in right ventricular failure in pulmonary hypertension vs. pulmonary stenosis. The right ventricle has very different responses to different afterload states. Pulmonary hypertension induces a dilatation of the right ventricular apex and an abnormal ventricular septal shift, which results in decreased left ventricular filling, and very pronounced post-systolic shortening. Interestingly, these findings are less pronounced in the case of pulmonary stenosis, even in the case of a comparable increase in right ventricular afterload.
Comprehensive imaging of the right ventricle is paramount given the heterogeneity of congenital heart disease. Future research will be critical to further understand the different physiologic responses of the right ventricle. This goal may be accomplished by cutting edge techniques of high frame rate imaging and by larger longitudinal studies.
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