The right ventricle: From physiology

to clinical applications

Antoine Vieillard-Baron, Boulogne, France

No disclosure for this lecture

(i)

The right ventricle is a “fragile” ventricle

TV closing

PV opening

PV closing

Redington Br Heart J 1990

Flow (inflow/outflow)

Rig

ht

atri

al p

ress

ure

The RV is functioning below

its unstressed volumeFluid overload may induce RV

failure

J Physiol 1914

Clinical application number 1

Intensive Care Med 2018

Am J Respir Crit Care Med 2002

Clinical application number 2

Elzinga 1990

“Anrep mechanism”

(ii) A certain “acute adaptation” to PH

is possible (in theory)

2 major limits in ICU

- Frequent systemic inflammation

- Associated hypotension

Circ Res 1954

Maximal pressure to which

the RV can compensate

(mmHg)

Just following VAC, PP 12 VAC 2 hours later

PP 12, low blood pressure

Vlahakes Circulation 1981

Control RV failure Phenylephrine

MAP 76+/-12 48+/-11 108+/-19

RVEDP 4+/-2 13+/-7 8+/-4

RV coronary

driving P

65+/-12 23+/-9 78+/-21

CO 2.8+/-0.8 1.5+/-0.8 2.4+/-07

SAP 80 mmHg NE 1µg/kg/min

SAP 110 mmHg

Clinical application number 3

RV is very sensitive to

hypotension and NE is a “good”

drug for the RV

(iii)

The RV shares a wall with the LV

Clinical application number 4

Any RV failure has an impact on

the LV

Circulation 1982

RV LV RV

LV

Am J Physiol 1957

(iv)

The right ventricle is key for the systemic

venous return

Am J Physiol 1959

Clinical application number 5

Look at the SVC

Am J Respir Crit Care Med 2017

(v)

The right ventricle is submitted to the

respiration….and is responsible for PPV

Clinical application number 6

Intensive Care Med 2016

CONCLUSION

• The RV is THE ventricle in the critically ill

patients

• A good knowledge of its physiology and

pathophysiology should help you to better

care your patients.

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