Right Ventricular Anatomy

Historically, the echocardiographic assessment of diseases affecting the right ventricle (RV) has lagged behind that of the left ventricle (LV), despite knowledge demonstrating that diseases affecting the right side of the heart have been shown to have important clinical consequences. The geometry of the RV is very complex in normal subjects and even more complex in diseased states, which makes it especially difficult to assess with two-dimensional (2D) techniques ( Video 27.1 ). The RV has a thin wall and has a circumferential arrangement of myofibers in the subepicardium and longitudinal fibers in the endocardium ( Fig. 27.1 ). ^, The RV assumes a flattened, pear-shaped appearance folded over the LV. It consists of three components: (1) an inlet portion consisting of the tricuspid valve, chordae tendineae, and papillary muscles; (2) a trabecular apical myocardium; and (3) an infundibulum or conus, which encompasses the smooth-walled RV outflow tract, beneath the pulmonic valve ( Fig. 27.2 ).

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Gross anatomic specimens of the right ventricle (RV) demonstrating circumferential arrangement of subepicardial myofibers ( A and B ) and longitudinal arrangement of myofibers in the subendocardium ( C ). Ao, Aorta; LV, left ventricle; PT, pulmonary trunk; TV, tricuspid valve.

Reproduced with permission from Ho SY, et al: Anatomy, echocardiography and normal right ventricular dimensions, Heart 92(Suppl 1): i2–i13, 2006.

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Anatomy of the right ventricle (RV). The RV has three distinct parts: an inlet component, which includes the tricuspid valve, chordae tendineae, and papillary muscles; an apical trabecular component, which includes the apical myocardium; and an infundibular or outlet component, which includes the smooth RV outflow tract up to the pulmonic valve.

Reproduced with permission from Bulwer BE, et al: Echocardiographic assessment of ventricular systolic function. In Solomon SD, editor: Essential Echocardiography , Totowa, NJ: Humana Press; 2007.

Video 27.1. Full-volume three-dimensional echocardiographic image of the right ventricle reconstructed with right ventricular software illustrating its complex shape in a normal participant.