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Mechanisms for heart failure in systemic right ventricle
Lauren Andrade1,2, Matthew Carazo3, Fred Wu4,5
1Division of Cardiology, University of Pennsylvania, Philadelphia, PA, USA. lauren.andrade@pennmedicine.upenn.edu.
Heart Failure Reviews
|December 20, 2019
Summary
The systemic right ventricle, seen in corrected transposition of the great arteries (CC-TGA) and post-atrial switch D-transposition of the great arteries (D-TGA), is linked to heart failure. This review explores the mechanisms behind this increased risk.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- The right ventricle (RV) is typically a low-pressure pulmonary pump.
- In certain congenital heart defects, the RV assumes the systemic circulation's high-pressure role.
- Systemic RV function is associated with adverse outcomes, including heart failure.
Purpose of the Study:
- To review the pathophysiology of heart failure in patients with a systemic RV.
- To elucidate the mechanisms leading to RV dysfunction in specific congenital heart conditions.
Main Methods:
- Literature review of studies on systemic RV function.
- Analysis of proposed pathophysiological mechanisms for heart failure in CC-TGA and post-atrial switch D-TGA.
- Synthesis of evidence regarding RV adaptation and failure in systemic circulation.
Main Results:
- Systemic RVs face increased afterload, leading to hypertrophy and eventual dilation.
- Impaired RV contractility and diastolic dysfunction are common.
- Potential mechanisms include altered myocardial energetics, valvular regurgitation, and ventricular interdependence.
Conclusions:
- The RV is not optimized for long-term systemic pressure loading.
- Understanding the mechanisms of systemic RV failure is crucial for improving long-term management and outcomes.
- Further research is needed to develop targeted therapies for heart failure in these populations.
Keywords:
Adult congenital heart diseaseCC-TGAD-TGAHeart failureSystemic right ventricleTransposition of the great arteriesMore Related Videos
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