Assessment of Right Ventricular Function

Abstract

In contrast to studies suggesting that the right ventricle (RV) often functions primarily as a conduit for blood flow from the venous circulation to the lungs, recent data show that the chamber plays a major role in maintenance of global cardiovascular homeostasis under many conditions. Accordingly, clinicians involved with the perioperative care of surgical patients must be familiar with factors influencing RV performance. Comprised of two embryologically distinct regions, the inflow and outflow tracts, the crescent-shaped RV exhibits characteristics of filling and contraction that are different from those of the left ventricle (LV). Furthermore, although the basic determinants of ventricular function (rate and rhythm, preload, afterload, and contractility) are the same for both the LV and RV, the relative contribution of each determinant to overall function of each chamber is somewhat different. This review approaches assessment of RV function from two directions. First, the anatomic and physiological differences between the RV and LV are described and used to show why some methods derived for complex characterization of LV function cannot be directly applied to the RV. Second, the application and limitations of methods used for perioperative assessment of RV function are discussed.Copyright© 1997 by W B. Saunders Company.In 1943, Starr et all reported that impairment of right ventricular (RV) free wall contraction in normal dogs produces little systemic hemodynamic alteration. Subsequent investigation showed similar results when the RV free wall was replaced with a synthetic patch.2 These studies indicated that when afterload to the RV is low, the chamber can function largely as a conduit for blood flow from the venous to pulmonary circulation. As an outgrowth of this perception, volume administration was advocated as a therapeutic approach to RV systolic dysfunction. However, it now appears clear that efficacy of this approach is often limited and that under many conditions, the RV must function as much more than a conduit. As improvements in diagnosis and medical therapy have made it possible for people with severe cardiopulmonary disease to survive for extended periods of time, these findings have assumed greater importance to clinicians associated with perioperative and/or critical care who find themselves increasingly confronted with the task of managing variable degrees of RV dysfunction. Multiple reviews related to RV pathophysiology have been published and provide considerable insight into medical management of chamber dysfunction.3-6 The following discussion will focus on a brief review of RV anatomy and current concepts in physiology, and then consider methods for assessing RV systolic performance, particularly those applicable to the perioperative setting. AnatomyStructurally distinct from the elongated ellipse geometry of the left ventricle (LV), the RV is a crescent-shaped structure largely wrapped around the interventricular septum (Fig 1). Normally, the RV has a relatively thin free wall th...

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