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New Insights �in Right Ventricular Failure

Assoc. Prof. Lê Minh Khôi, MD, FACC

Heart Center, University Medical Center HCMC

Department of Critical Medicine

University of Medicine and Pharmacy at Ho Chi Minh City

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A clinical syndrome

Definition of Right Ventricular Failure

Inadequate forward flow to meet metabolic demand.

Systemic congestion

Impaired right ventricle

Magder S, et al. Am J Respir Crit Care Med 2022;207:678-92.

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The “forgotten ventricle”

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Jacobs & Pellertier CTSNet 2013

Boston Children’s Hospital

Fontan procedure

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Tarras E, et al. J Int Care Med 2025;40: 119-136.

Right ventricular geometry

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Konstam et al. Circulation. 2018; 137:e578–e622.

Right ventricular function

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​

Decreased RV contractility

RV volume overload

RV pressure overload

A

C

U

T

E

Sepsis

Acidosis

LVAD support

Hypoxia

RVMI

Excessive transfusion

PE

Myocarditis

​

ARDS

Perioperative injury/ischemia

​

Positive pressure ventilation

C

H

R

O

N

I

C

RV cardiomyopathy

Left heart disease

Arrhythmogenic RV cardiomyopathy

Single ventricle

Ebstein anomaly

​

Pericardial disease

​

Pulmonary regurgitation

PA hypertension

​

Transposition of Great Arteries

Chronic thromboembolic PH

​

Tricuspid regurgitation

Pulmonary stenosis

​

​

Left-sided valvular disease

​

​

Restrictive cardiomyopathy

Etiologies of RV failure

Konstam et al. Circulation. 2018; 137:e578–e622

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​

Decreased RV contractility

RV volume overload

RV pressure overload

A

C

U

T

E

Sepsis

Acidosis

LVAD support

Hypoxia

RVMI

Excessive transfusion

PE

Myocarditis

​

ARDS

Perioperative injury/ischemia

​

Positive pressure ventilation

C

H

R

O

N

I

C

RV cardiomyopathy

Left heart disease

Arrhythmogenic RV cardiomyopathy

Single ventricle

Ebstein anomaly

​

Pericardial disease

​

Pulmonary regurgitation

PA hypertension

​

Transposition of Great Arteries

Chronic thromboembolic PH

​

Tricuspid regurgitation

Pulmonary stenosis

​

​

Left-sided valvular disease

​

​

Restrictive cardiomyopathy

Etiologies of RV failure

Konstam et al. Circulation. 2018; 137:e578–e622

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Kanwar MK, et al. EHJ. Acute Cardiovascular Care 2022,;11: 584–594.

Etiologies of RV failure

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Right ventricular presure overload: Systemic RV

Drs. Aiello & Rossi (University of São Paulo Medical School, Brasil)

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Mechanisms of Right Ventricular Failure

Houston et al. N Engl J Med. 2023; 388:1111-25.

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Konstam et al. Circulation. 2018; 137:e578–e622.

Pathophysiology

of

cardiorenal disease

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Diagnosis of Right Ventricular Failure

Ro SK et al. Front Cardiovasc Med. 2023 May 30;10:1030864.

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Dilated right ventricle

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Severe tricuspid regurgitation

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Dilated IVC, reduced collapsibility

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Reversal flow in IVC and HVs

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Increased RV pressure

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Preserved Tissue Doppler velocity

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Preserved TAPSE

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Reduced RV Fractional Area Change

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Reduced RV strain

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Abnormal ventricular interdependence

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Abnormal ventricular interdependence

Still

not

impressed?

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Luk A, et al. Canadian J Cardiol. 2025 doi:10.1016/j.cjca.2025.02.006.

Managememt of Right Ventricular Failure

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Kanwar MK, et al. EHJ. Acute Cardiovascular Care 2022,;11: 584–594.

Management of RV-predominant cardiogenic shock