Hemodynamics of the right ventricle and the pulmonary circulation

Abstract

Most cardiac diseases affect the left ventricle (LV), with its treatment being the focus of the majority of cardiovascular medical therapies and mechanical support. Many diseases also affect the right ventricle (RV) and pulmonary circulation, either directly or from secondary effects on the LV and systemic circulation. The development of therapies to treat RV failure is critical for the management of many patients with advanced heart and lung disease, but models to develop mechanical therapies to target the RV are currently lacking. While the RV and pulmonary vasculature have many similarities to the LV and systemic vasculature, there are notable differences between them at a morphological and functional level. This results in distinct patterns of coupling between the RV and pulmonary circulation. Models such as the Windkessel use lumped parameters that characterize the mechanical properties of the entire RV and pulmonary circulation. Contemporary computational approaches that have been used to model the pulmonary vasculature rely on patient-derived anatomy for the proximal pulmonary arteries and other approaches, such as fractal-based models for the distal vasculature. At this time, these models are still being optimized and significantly more work will be required to fully implement them and test their utility across multiple patient-derived anatomies. The development of these models for the RV and pulmonary circulation will be critical to address the unmet need of mechanical therapies for disease of the RV and pulmonary circulation.