Assessment of right heart function remains difficult despite rapid technological echocardiographic developments. This review addresses the anatomical and physiological basis for assessment of right ventricular function. It also addresses advantages and limitations of individual echocardiographic techniques currently used in clinical and academic practice. The review concludes that volume calculation and estimation of ejection fraction is not ideal for clinical assessment of right ventricular function. Regional myocardial wall motion detection by M-mode and tissue Doppler velocities are probably the best useful methods in clinical practice. 1D and 2D strain, velocity vector imaging and 4D echocardiography need further evaluation before considering them as routine investigations. A global interest needs to be given to a very important neglected entity, 'right ventricle', which has been shown to predict exercise tolerance and outcome in a number of syndromes.

The right ventricle has distinct features for the inflow, apical and outflow tract compartments, with different extent of contribution to the overall systolic function. In PAH, the right ventricle becomes one dyssynchronous compartment, which itself may have perpetual effect on overall cardiac dysfunction.

PH has drastic effects on RV structure and intrinsic myocardial function, significantly disturbing its ejection time relations and overall pump performance. Increased RV afterload results in RV configuration changes with the inflow tract determining peak ejection rather than OT.

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