Right ventricular (RV) dysfunction is important determinant of prognosis in patients at increased risk for development of RV overload. RV dysfunction in patients before and after surgical left... Show moreRight ventricular (RV) dysfunction is important determinant of prognosis in patients at increased risk for development of RV overload. RV dysfunction in patients before and after surgical left ventricular restoration is associated with a worse prognosis. RV overload in liver transplantation recipients was also associated with decreased survival. Furthermore, patients with congenital heart disease and an systemic RV are at increased risk for long-term complications caused by RV overload. No unique golden standard for the quantification of RV dysfunction exists. The combination of echocardiographic RV parameters yields additional prognostic information in heart failure patients undergoing surgical left ventricular restoration. In systemic sclerosis the electrical ventricular gradient can accurately detect RV overload and is consistent with other screening parameters in patients with limited organ involvement. Optimization of loading conditions can improve clinical status and RV function in patients with RV dysfunction. RV function can be improved in LVAD patients by optimizing the synergy between the LVAD and intrinsic cardiac function. Furthermore, interventions in complex congenital heart disease patients with pulmonary hypertension can improve RV loading conditions and true pulmonary flow and can improve RV loading conditions and clinical functioning. Show less
Right ventricular overload covers a spectrum ranging from volume overload to pressure overload, and often is a combination of these, compromising cardiac function. Part I focuses on right... Show moreRight ventricular overload covers a spectrum ranging from volume overload to pressure overload, and often is a combination of these, compromising cardiac function. Part I focuses on right ventricular volume overload in adults with Fallot__s tetralogy corrected in early childhood. We determined which patient characteristics are associated with a more prompt recovery time after surgical pulmonary valve replacement. Furthermore, we analyzed what may be expected from pulmonary valve replacement with respect to right ventricular reverse remodeling. We also determined that pulmonary valve replacement has a positive effect on myocardial repolarization characteristics in adult Fallot patients. Part II addresses right ventricular pressure overload due to pulmonary arterial hypertension. Development of pulmonary arterial hypertension in rats induced characteristic evolutionary changes in right ventricular morphology and function, as monitored with electrocardiography, echocardiography, and heart catheterization. The documented evolutionary electrocardiographic changes in evolving right ventricular pressure overload in rats were similar to the abnormalities found in patients with varying degrees of pulmonary arterial hypertension. Electrocardiographic cut-off points can be useful for monitoring treatment response in pulmonary arterial hypertension patients. Finally, resting heart rate, reflecting hemodynamics and neurohumoral activation, is an important prognosticator in pulmonary arterial hypertension, and should be addressed at frequent intervals. Show less
