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Updated: Feb 24, 2026

Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
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Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography

Published on: October 28, 2020

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Clinical and echocardiographic features of right ventricular dysfunction and biventricular dysfunction in children

Karla L Loss1, Andrew L Cheng2,3, Molly Weisert2,3

  • 1Department of Pediatrics, Federal University of Espirito Santo, Vitoria, Espirito Santo, Brazil.

Annals of Pediatric Cardiology
|February 23, 2026
PubMed

Insights

Pediatric right ventricular dysfunction is often overlooked. Isolated RV dysfunction presents milder symptoms and fewer adverse outcomes compared to biventricular dysfunction, which carries high cardiovascular risks.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Imaging
  • Pediatric Critical Care

Background:

  • Right ventricular (RV) systolic dysfunction is an uncommon condition in children, frequently underdiagnosed.
  • This study focuses on the clinical and imaging features of RV dysfunction in pediatric patients.
  • It compares the characteristics of isolated RV dysfunction with biventricular dysfunction (BVD).

Purpose of the Study:

  • To describe the clinical and imaging characteristics of RV dysfunction in a pediatric population.
  • To compare the features of isolated RV dysfunction with those of biventricular dysfunction.
  • To identify echocardiographic predictors of severe RV dysfunction in children.

Main Methods:

  • Retrospective analysis of echocardiographic, cardiac MRI, and clinical data from pediatric patients with RV dysfunction (January 2015-March 2022).
  • RV dysfunction defined as RV ejection fraction (RVEF) <45% by cardiac MRI; severe RV dysfunction defined as RVEF <35%.
  • Patients categorized into isolated RV dysfunction or BVD based on left ventricular ejection fraction <50%.

Main Results:

  • Sixty-five children were included; 49.2% had isolated RV dysfunction, 50.8% had BVD.
  • Isolated RV dysfunction patients reported milder symptoms (NYHA class I-II: 96.9% vs. 57.6%) compared to BVD patients.
  • Adverse cardiovascular outcomes occurred in BVD patients (4/33) but not in isolated RV dysfunction patients (0/32).
  • A combination of fractional area change (FAC) <35% and qualitative RV dysfunction on echocardiogram best predicted severe RV dysfunction by MRI.

Conclusions:

  • Pediatric patients with isolated RV dysfunction exhibit milder symptoms and a lower risk of adverse cardiovascular outcomes compared to those with BVD.
  • Biventricular dysfunction in children is associated with a high risk of adverse cardiovascular events.
  • Combining abnormal FAC with qualitative assessment on echocardiography improves the prediction of severe RV dysfunction in pediatric patients.
Abstract

Keywords:
Cardiac magnetic resonance imagingLV dysfunctionRight ventricleechocardiographyheart failurepediatric

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