The Role of Right Ventricular Embryology in Echocardiographic Assessment of RV Function

The right ventricle (RV) possesses a complex geometry and unique functional characteristics stemming from its embryologic development. Unlike the left ventricle (LV), which arises primarily from the primary heart field, the RV originates predominantly from the anterior or secondary heart field, influencing its structural organization, myocardial fiber orientation, and contractile patterns. This embryologic origin is not only essential for understanding congenital anomalies but also profoundly impacts the interpretation and accuracy of echocardiographic modalities used to assess RV function. This review explores how knowledge of RV embryology enhances the clinical application of echocardiographic methods, including tricuspid annular plane systolic excursion (TAPSE), tissue Doppler imaging (TDI), RV fractional area change (FAC), 3D echocardiography, and RV longitudinal strain. Incorporating embryologic insights provides a more anatomically and physiologically grounded approach to evaluating RV performance, especially in congenital heart disease and right heart failure.