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Anatomical features of the right ventricle demonstrating the internal structures discussed. (Illustration by Katie Yost ©2019, provided under CC-BY-NC-ND).
Source publication
Background
The right ventricle is the most anteriorly positioned chamber of the heart, sitting directly posterior to the sternum. The distinct anatomical features of the right ventricle create an approximately 10-fold difference in vascular resistance between the right and left ventricular systems. We will first review the external and general feat...
Context in source publication
Context 1
... Thus, a three-part description proposed by Goor and Lillehi (1977) was adopted. They described the RV as being composed of: 1) the inlet -including the tricuspid valve, chordae tendineae, and papillary muscles; 2) the trabeculated apical myocardium; 3) the outlet -including the infundibulum or conus and the pulmonary valve [5,[10][11][12][13] (Fig. 2). According to Muresian, this three-compartment model appears more useful and correct from an embryological point of view [1]. Each of these three parts will be discussed in the following ...
Citations
... During ventricular contraction, the PM relocates the cups to their systolic position, reducing the possibility of ventricular regurgitation; however, pathological alterations such as ventricular dilatation, degenerative cardiomyopathy, post-infarction akinesia of the wall segment that includes the PM or reduction in size of the PM/CT would produce alteration of the valve dynamics and consequently myocardial dysfunction (Wang et al., 2019;Whiteman et al., 2021). ...
Papillary muscles in the left ventricle present multiple anatomic expressions that are relevant for medical fields focusing on the understanding of clinical events involving these structures. Here, the aim was to perform a morphological characterization of the left ventricle papillary muscles in a sample of Colombian population. In the study were included eighty-two hearts from male individuals who underwent autopsy at the Institute of Legal Medicine and Forensic Sciences in Bucaramanga, Colombia. In each heart was carefully performed a longitudinal incision on the obtuse margin to visualize the papillary muscles. Data set was registered, and analysis of the continuous and categorical variables was carried out. Single anterior papillary muscle was observed in 74 samples (90.2 %) whereas this represented only 48 specimens (58.5 %) for the posterior papillary muscle (p = 0.3). Mean length and breadth of the anterior muscle were 29.9 ± 4.94 and 11.74 ± 2.75 mm, and those for the posterior muscle were 27.42 ± 7.08 and 10.83 ± 4.08 mm. Truncated apical shape was the most frequent type observed on the papillary muscles, anterior 41 (50 %) and posterior 37 (45.1 %), followed by flat-topped in the anterior 25 (30.5 %) and bifurcated in posterior muscle 14 (17.1 %). A mean of 9.04 ± 2.75 chordae raised from the anterior and 7.50 ± 3.3 from posterior papillary muscle. In our study we observed a higher incidence of single papillary muscles and slightly larger dimensions than information reported in the literature. The anatomic diversity of the papillary muscles should be considered for the correct image interpretation, valve implantation and performance evaluation on myocardial ischemic events.
... anterior papillary muscle to the ventricular septum, type II RVFTs connect the posterior papillary muscle to the ventricular septum, type III RVFTs connect the right ventricular free wall to the anterior leaflet of the tricuspid valve, type IV RVFTs connect the ventricular free wall to the posterior papillary muscle, and type V RVFTs connect the ventricular free wall to the anterior papillary (Figure 5).(Loukas et al., 2008;Wang et al., 2019) In a similar study,Kosi nski et al. (2012) identified RVFTs in 100% of the heart specimens. These structures were then classified into six types: type 1 RVFTs connect papillary muscles with the outer wall of the ventricle, type 2 RVFTs connect individual segments of the papillary muscles, type 3 RVFTs connect papillary muscles with the interventricular septum, type 4 RVFTs connect various papillary muscles, type 5 RVFTs connect the walls of the ventricle around its apex, and type 6 RVFTs connect septomarginal trabecula with other structures of the right ventricle.Singh et al. (2018) incidentally found right ventricular false tendons in 2 of 52 cadaveric hearts in North Indians during a study on the tricuspid valve. ...
Ventricular false tendons are fibromuscular structures that travel across the ventricular cavity. Left ventricular false tendons (LVFTs) have been examined through gross dissection and echocardiography. This study aimed to comprehensively evaluate the prevalence, morphology, and clinical importance of ventricular false tendons using a systematic review. In multiple studies, these structures have had a wide reported prevalence ranging from less than 1% to 100% of cases. This meta‐analysis found the overall pooled prevalence of LVFTs to be 30.2%. Subgroup analysis indicated the prevalence to be 55.1% in cadaveric studies and 24.5% in living patients predominantly studied by echocardiography. Morphologically, left and right ventricular false tendons have been classified into several types based on their location and attachments. Studies have demonstrated false tendons have important clinical implications involving innocent murmurs, premature ventricular contractions, early repolarization, and impairment of systolic and diastolic function. Despite these potential complications, there is evidence demonstrating that the presence of false tendons can lead to positive clinical outcomes.
... As has been stated on several previous occasions, the right ventricle is very much the poor relation of its left ventricular counterpart (Ho & Nihoyannopoulos, 2006;Stubbs et al., 2023;Wang et al., 2019). ...
... Discussions continue, for example, as to whether the tricuspid valve truly possesses three leaflets (Hołda et al., 2019;Schlossbauer et al., 2021;Tretter et al., 2016;Victor & Nayak, 1994). As pointed out in an earlier review (Muresian, 2016), it has also been debated as to whether the ventricle itself possesses two (Kumar et al., 1997;Van Praagh et al., 1979, 1989 or three (Ho & Nihoyannopoulos, 2006;Mori et al., 2019;Muresian, 2016;Wang et al., 2019) parts. Those arguing for the bipartite approach suggest that the apical part, which accounts for the third component in the tripartite model, can itself be considered to possess inlet and apical extensions (Kumar et al., 1997;Van Praagh et al., 1979). ...
... postnatal morphology of the human and murine hearts, the similarities of the developmental processes are sufficiently coherent to permit direct comparisons between the two species. As we emphasised in our introduction, the right ventricle has usually been seen as the poor relation of its left ventricular counterpart (Ho & Nihoyannopoulos, 2006;Stubbs et al., 2023;Wang et al., 2019). It was initially described as possessing two rather than three components. ...
Controversies continue regarding several aspects of the anatomy of the morphologically right ventricle. There is disagreement as to whether the ventricle should be assessed in bipartite or tripartite fashion, and the number of leaflets to be found in the tricuspid valve. In particular, there is no agreement as to whether a muscular outlet septum is present in the normally constructed heart, nor how many septal components are to be found during normal development. Resolving these issues is of potential significance to those investigating and treating children with congenitally malformed hearts. With all these issues in mind, we have revisited our own experience in investigating the development and morphology of the normal right ventricle. To assess development, we have examined a large number of datasets, prepared by both standard and episcopic microscopy, from human and murine embryos. In terms of gross anatomy, we have compared dissections of normal autopsied hearts with virtual dissections of datasets prepared using computed tomography. Our developmental and postnatal studies, taken together, confirm that the ventricle is best assessed in tripartite fashion, with the three parts representing its inlet, apical trabecular, and outlet components. The ventricular septum, however, has only muscular and membranous components. The muscular part incorporates a small component derived from the muscularised fused proximal outflow cushions, but this part cannot be distinguished from the much larger part that is incorporated within the free‐standing muscular infundibular sleeve. We confirm that the tricuspid valve itself has three components, which are located inferiorly, septally, and antero‐superiorly.
... This heart disease is a syndrome characterised by the inability of the cardiac output to match the body's metabolic demands, stemming from structural or functional impairment of ventricular filling or ejection. There are, however, two predominant conditions where the anatomic right ventricular (RV) lies in the systemic position and the anatomic left ventricular (LV) lies in the subpulmonary position, namely d-Transposition of the great arteries (d-TGA), which is palliated with an atrial switch operation, and congenitally corrected transposition of the great arteries (cc-TGA) [2] Most patients with symptoms and signs of heart failure have a left ventricular ejection fraction that is not markedly abnormal [3]. The recognition of the magnitude of the problem of heart failure with preserved ejection fraction in the past 20 years has spurred an explosion of clinical investigation and a growing intensity of informative outcome trials [4]. ...
Right ventricular heart failure (RVHF) mostly occurs due to the failure of the left-side of the heart. RVHF is a serious disease that leads to swelling of the abdomen, ankles, liver, kidneys, and gastrointestinal (GI) tract. A total of 506 heart-failure subjects from the Faculty of Medicine, Cardiovascular Surgery Department, Ege University, Turkey, who suffered from a severe heart failure and are currently receiving support from a ventricular assistance device, were involved in the current study. Therefore, the current study explored the application of both the direct and inverse modelling approaches, based on the correlation analysis feature extraction performance of various pre-operative variables of the subjects, for the prediction of RVHF. The study equally employs both single and hybrid paradigms for the prediction of RVHF using different pre-operative variables. The visualized and quantitative performance of the direct and inverse modelling approach indicates the robust prediction performance of the hybrid paradigms over the single techniques in both the calibration and validation steps. Whereby, the quantitative performance of the hybrid techniques, based on the Nash–Sutcliffe coefficient (NC) metric, depicts its superiority over the single paradigms by up to 58.7%/75.5% and 80.3%/51% for the calibration/validation phases in the direct and inverse modelling approaches, respectively. Moreover, to the best knowledge of the authors, this is the first study to report the implementation of direct and inverse modelling on clinical data. The findings of the current study indicates the possibility of applying these novel hybridised paradigms for the prediction of RVHF using pre-operative variables.
... The PV in the vast majority of cases consists of three semilunar leaflets fixed to the walls of the pulmonary root through a crown-shaped fibrous annulus; however, PVs with only two, or more than three leaflets, may also exist (Solewski et al., 2020). The pulmonary annulus is not a well-defined structure for macroscopic identification (Misfeld & Sievers, 2007;Wang et al., 2019). Thin layers of tight collagenous tissue, constituting the leaflet insertion line (hinge line), can be discerned in a microscopic examination (Lis et al., 2021). ...
In this cadaver‐based study, we aimed to present a novel approach to pulmonary valve (PV) anatomy, morphometry, and geometry to offer comprehensive information on PV structure. The 182 autopsied human hearts were investigated morphometrically. The largest PV area was seen for the coaptation center plane, followed by basal ring and the tubular plane (626.7 ± 191.7 mm² vs. 433.9 ± 133.6 mm² vs. 290.0 ± 110.1 mm², p < 0.001). In all leaflets, fenestrations are noted and occur in 12.5% of PVs. Only in 31.3% of PVs, the coaptation center is located in close vicinity of the PV geometric center. Similar‐sized sinuses were found in 35.7% of hearts, in the remaining cases, significant heterogeneity was seen in size. The mean sinus depth was: left anterior 15.59 ± 2.91 mm, posterior: 16.04 ± 2.82 mm and right anterior sinus: 16.21 ± 2.81 mm and the mean sinus height: left anterior 15.24 ± 3.10 mm, posterior: 19.12 ± 3.79 mm and right anterior sinus: 18.59 ± 4.03 mm. For males, the mean pulmonary root perimeters and areas were significantly larger than those for females. Multiple forward stepwise regression model showed that anthropometric variables might predict the coaptation center plane (sex, age, and heart weight; R² = 33.8%), tubular plane (sex, age, and BSA; R² = 20.5%) and basal ring level area (heart weight and sex; R² = 17.1%). In conclusion, the largest pulmonary root area is observed at the coaptation center plane, followed by the basal ring and tubular plane. The PV geometric center usually does not overlap valve coaptation center. Significant heterogeneity is observed in the size of sinuses and leaflets within and between valves. Anthropometric variables may be used to predict pulmonary root dimensions.
... [1][2][3][4][5][6] The right ventricle (RV) is difficult to assess due to its complex morphology and function 7 but can be broadly divided into three parts: the smooth muscular inflow (body), the outflow tract, and the trabecular apical region. 8 Although echocardiography has traditionally been used as the primary modality to evaluate the right heart, conventional M-mode and 2D echocardiography provide only a limited and poorly reproducible assessment of the actual RV size and function. 9 Moreover, the use of conventional M-mode and 2D echocardiography has been reported to provide inconsistent identification of RV dysfunction. ...
Aims
The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey to evaluate the use of different cardiac imaging modalities for the evaluation of the right heart.
Methods and results
Delegates from 250 EACVI registered centres were invited to participate in a survey which was also advertised on the EACVI bulletin and on social media. One hundred and thirty-eight respondents from 46 countries across the world responded to the survey. Most respondents worked in tertiary centres (79%) and echocardiography was reported as the commonest imaging modality used to assess the right ventricle (RV). The majority of survey participants (78%) included RV size and function in >90% of their echocardiographic reports. The RV basal diameter obtained from the apical four-chamber view and the tricuspid annular plane systolic excursion were the commonest parameters used for the echocardiographic assessment of RV size and function as reported by 82 and 97% respondents, respectively. Survey participants reported arrhythmogenic cardiomyopathy as the commonest condition (88%) where cardiac magentic resonance (CMR) imaging was used for right heart assessment. Only 52% respondents included RV volumetric and ejection fraction assessments routinely in their CMR reports, while 30% of respondents included these parameters only when RV pathology was suspected. Finally, 73% of the respondents reported pulmonary hypertension as the commonest condition where right heart catheterization was performed.
Conclusion
Echocardiography remains the most frequently used imaging modality for the evaluation of the right heart, while the use of other imaging techniques, most notably CMR, is increasing.
... The RV wall is about 2-5 mm in thickness, 25 ± 5g/m2 in weight, and mainly composed of deep and superficial muscle layers [9], In our study, the mean thickness of the right ventricular wall was found to be 9 mm. The muscular wall of the normal RV is usually 3 to 5 mm in thickness, but in conditions of pressure overload, the RV wall thickness may even exceed that of the LV [10] Our present study also showed a more than the usual thickness of right ventricular wall. ...
Background: The left ventricle is longer and narrower than the right ventricle, extending from its base in the plane of the atrioventricular groove to the cardiac apex. The wall of the left ventricle is three times thicker (8-12 mm) than those of right ventricle. The wall of the right ventricle is relatively thin (3–5 mm), the ratio of the thickness of the two ventricular walls usually being 1:3. Hypertrophic cardiomyopathy is characterized by myocardial wall thickening, particularly a disproportionate thickening of the interventricular septum in comparison with the posterior wall. An athlete’s heart may physiologically hypertrophy but in a uniform fashion. The objective of the study is to determine the thickness of wall of right and left ventricle of adult human heart and ratio of thickness of right and left ventricle. Materials and Methods: Adult human hearts were procured from the specimens preserved in Anatomy Department of Jawaharlal Nehru Institute of Medical Sciences. A cross-sectional study was conducted on forty- four specimen of adult heart. The measurement of the right and left ventricular wall was done with digital vernier caliper. The measurements were done at three levels in both right and left ventricle: upper, middle and lower part. Result and Conclusion: The ratio of the thickness of the wall of right and left ventricle is well known as 1:3. However, in our study we found the ratio as 1:1.4. We found the thickness of the right ventricle thicker than the normal thickness reported in previous studies. We wish to continue the study with a larger sample size. KEY WORDS: Heart, Right ventricle, left ventricle, Thickness Ratio, Myocardium.
... In theory, chordae come off 3 papillary muscles. In practice, a large anterior papillary muscle originates from the free right ventricular wall and inferior and septal papillary muscles may or may not be fully expressed and chordae may originate from the septum or the ventricular wall directly [5]. Figure 1 schematically shows the principle mechanism of action of the subvalvular technique. ...
... This new subvalvular technique for severe cases of TR is safe and may generate a durable repair. Subvalular techniques have been described for the mitral valve achieving promising results [3,5] including a potential impact on prognosis [4]. To our knowledge, no such technique has thus far been described for the tricuspid valve, but the restrictive mechanism stemming from papillary dispositioning caused by ventricular dilatation is generally the same. ...
... To our knowledge, no such technique has thus far been described for the tricuspid valve, but the restrictive mechanism stemming from papillary dispositioning caused by ventricular dilatation is generally the same. However, the above described differences in anatomy [5] pose a challenge. Our technique therefore focuses on securing a Goretex suture to the largest present papillary muscle (generally the anterior muscle), and level guide one arm of the suture with possibly additionally available papillary muscles (often the posterior one) and one arm with the septum itself. ...
Annular dilatation is the main mechanism for tricuspid regurgitation, but right ventricular dilatation often adds a restrictive mechanism, which may limit durability. We describe a subvalvular technique anchoring the chordal origins to the annuloplasty, with the aim to stabilize valve geometry and increase durability. A Goretex suture is attached to the anterior papillary muscle. One arm of the suture is stitched through the septal muscle and both arms are atrialized underneath the septal leaflet and tied to the annuloplasty band. In 12 patients (75 ± 6 years, EuroSCORE II 10 ± 9%), severe-torrential tricuspid regurgitation was successfully reduced to mild. Results were stable in all but one patient during follow-up (1–15 months). NYHA class and general health status was improved. This subvalvular technique is safe with the potential to generate a durable repair.
... RV coronary perfusion occurs throughout the cardiac cycle. 3 Left coronary artery flow is predominantly in diastole only. Under steady-state conditions, the Fick equation can be used to calculate myocardial oxygen uptake (MVO 2 ), such that: ...
... Oxygen extraction in the LV is nearly maximal (70-80%) under baseline conditions; thus, an increase in LV oxygen uptake is essentially dependent on a proportional increase in blood flow. 3 Myocardial oxygen extraction (MEO 2 ), as a percentage, is calculated from measurements of CaO 2 and CvO 2 : ...
The healthy right ventricle (RV) has a thin-walled structure compared to the thick-walled left ventricle (LV). It has a complex shape that appears crescentic when viewed in cross section and triangular when viewed from the side.
... The Valentine position makes us believe that the right atrium is just a tiny fragment, when really it is quite big cavity. It consists of the following main parts: venous component (located posteriorly), an appendage (located anteriorly, superiorly and laterally) and a vestibule [9][10][11][12]. The correct orientation of the heart would show that the superior vena cava is not draining into the right atrium perpendicularly; rather, it enters the atrium obliquely, at the superior end of the right atrium, slightly to the right to the interatrial septum [9]. ...
Proper heart's nomenclature is very important in daily clinical practice and research studies, and when it is consistent, it can facilitate better communication between different medical specialists. The general rule of the anatomy is to describe organs and their structures in attitudinally correct position. However, the use of the old-fashioned Valentine position (where the heart is described as if it were standing on its apex) is still in use to describe important cardiac structures. Upon closer analysis, all main chambers of the heart and their associated subcomponents have mislabeled structures that should be renamed. In this article we aimed to emphasize the limitations of Valentinian nomenclature, present proper anatomical names of the most important heart's structures and advocate to change certain mislabeled anatomical structures. Attitudinally correct designations presented in this study will benefit all medical specialties, and they will reinforce the importance of consistent orientational naming. Correct naming of heart's structures will also help improve communication between different medical specialists.
