The Right Heart and Pulmonary Circulation: Is It Really a Minor Circulation?

Abstract

Continued education has traditionally been considered to be of great importance in Revista Espanola de Cardiologia. The “Editorial,” “Review Article,” and “Update” sections are the usual means for transmitting to readers the opinions and points of view of experts of known prestige in the different aspects of cardiovascular disease. In the case of the Update section, over the years we have attempted to select areas of obvious interest to a large part of our readers that, not being the object of attention in more classical reviews, would otherwise be overlooked. Thus, the subjects we have attempted to address in a cross-cutting manner in recent years include: “Cardiovascular disease in women” (2006),1 “Non-coronary arterial disease” (2007),2 “Cardiovascular prevention” (2008),3 and “Cardiovascular translational medicine” (2009).4 The subject selected this year for in-depth evaluation, “The right heart and pulmonary circulation,” encompasses several aspects that are undoubtedly attractive. The first is its evident implication in the practice of cardiologists of all hues, whether general or specialized, ranging from those devoted to clinical activity to basic researchers. On the other hand, after decades of highly predominant attention to the left chambers of the heart and the systemic vessels, over the last 15 years we have been witnessing a progressive awareness of the importance of right ventricle (RV) dysfunction in different heart diseases,5 both in those cases in which this chamber plays the leading role in the condition (as in arrhythmogenic right ventricular dysplasia or certain congenital heart diseases) and in those in which it accompanies conditions involving the left heart chambers and valves, significantly modifying the clinical signs and prognosis. To paraphrase the title of a recent report, we now consider that “the left heart will only be able to work as much as the right heart lets it.”6 With respect to the pulmonary circulation, the past decade has witnessed important advances based on a more complete knowledge of the pathophysiology of the different forms of pulmonary hypertension, which has been expressed in a classification that is of evident practical utility, as well as an improved diagnostic approach and, what is more important, the possibility of employing treatments that are useful for the improvement of the symptoms and the prognosis of these patients. Therefore, this Update arrives just in time to help us learn about the latest findings, incorporate the diagnostic and therapeutic advances into our clinical practice and become aware of the uncertainties and gaps left by our current knowledge. The editors of Revista Espanola de Cardiologia can state with pride that among the authors who have agreed to contribute their knowledge to this series of monographs are the major world experts in this field. Approximately half of the reports are written by authors living in the United States, and half were submitted by specialists from different European countries.