Chronic right heart failure

Abstract

Right heart failure (RHF) represents a disturbance or dysfunction in any of the components that constitute the right heart circulatory system. The right ventricle is overshadowed by the left ventricle and the crescent-shaped right ventricle is anatomofunctionally different from the conical-shaped left ventricle due to its myocardial structure. The central component of the anatomofunctional relationship between both ventricles is the interventricular septum. Several pathologies affecting the right ventricle do not usually impair right ventricular functions because the interventricular septum remains intact in most cases, thus enabling the right ventricle to withstand acute or chronic cardiac dysfunctions for long periods and delaying the development of RHF. On the other hand, RHF leads several pathological changes involve not only the cardiovascular system, but also the hepatic, renal, neuroendocrinological, immunological, musculoskeletal, hematologic, gastrointestinal systems, and nutritional status. Congestive multiorgan dysfunctions should be treated initially, and then these patients should be listed for transplantation or mechanical assist device implantation. Understanding of pathophysiology and structural changes of the right ventricle will open new treatment options in near future. Percutaneous right heart bypass systems will also take first place to support the rightsided cardiac output; maybe, for long-term implantation.