Right ventricular failure

Whilst failure of the left ventricle (LV) has been the subject of intense interest for decades, failure of the right ventricle (RV) has tended to receive scant attention. Indeed, the RV was long considered a relatively passive conduit for blood flow between the systemic and pulmonary circulations. More recently, the importance of the RV in maintaining haemodynamic stability and organ function has been recognized. It is now known that RV failure is not only as common as LV failure, but also that isolated RV failure may carry a worse prognosis than isolated LV failure. RV failure presents unique challenges in identification and management. Therefore, for an anaesthetist, a good understanding of both RV physiology and the impact of RV dysfunction is essential in order to safely manage these potentially complex patients. This review aims to provide a broad overview of RV physiology and of the pathophysiology of RV failure. General haemodynamic aims and specific therapies will be discussed.