Abstract
The primary function of the right ventricle (RV) is to receive systemic venous return and pump it into the normally low-pressure, highly distensible pulmonary arterial system.1 Compared to the left ventricle (LV), the RV is thinner with less mass, has 2 layers of muscles rather than 3, and has a bellow shape rather than an ellipsoid shape. Due to its typically low afterload, the metabolic demand for the RV is lower. The normal RV stroke work index is at 25% of the LV.2 Animal studies have shown that the right coronary artery flow is lower, the oxygen extraction is lower in the RV compared to the LV, and the mean RV myocardial oxygen consumption is less than half that of the LV.34 The study of myocardial metabolism has been dominated by studies of the LV metabolism until recently, with increasing recognition that RV performance affects patients' morbidity and mortality in patients with pulmonary hypertension5 and even in patients with left-sided heart failure.6
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