Right Ventricular Function in Left Heart Disease

Area of Science:

• Cardiology
• Cardiac Surgery
• Cardiovascular Physiology

Background:

• Right ventricular (RV) function is a key prognostic indicator in cardiac surgery.
• Mitral valve (MV) disease significantly elevates the risk of RV dysfunction, both pre- and post-operatively.
• Current clinical decision-making and risk stratification for MV disease often neglect RV function.

Purpose of the Study:

• To review the pathophysiology and prognostic implications of RV dysfunction in patients with MV disease during the perioperative period.
• To explore mechanisms beyond pulmonary hypertension (PHTN) through which MV disease affects RV performance.
• To highlight the independent prognostic significance of both RV dysfunction and PHTN.

Main Methods:

• Literature review focusing on RV function, MV disease, and perioperative outcomes.
• Analysis of existing research on the interplay between MV disease, PHTN, and RV performance.
• Exploration of the unique anatomical and functional characteristics of the RV.

Main Results:

• Pulmonary hypertension (PHTN) is a known consequence of MV disease impacting RV function.
• Emerging evidence suggests PHTN may not be the sole or primary driver of RV dysfunction in this context.
• Both RV dysfunction and PHTN possess independent prognostic value.

Conclusions:

• RV dysfunction is a critical, yet often underappreciated, factor in patients with MV disease undergoing surgery.
• A comprehensive understanding of RV function is crucial for accurate risk stratification and improved patient outcomes.
• Further research into non-PHTN mechanisms affecting RV performance in MV disease is warranted.