Right ventricle in congenital heart disease: is it just a "weaker" left ventricle?

The RV is the dominant ventricle during fetal life. Postnatally, the RV rapidly loses its ability to sustain systemic load. In several forms of congenital heart disease, the RV is the dominant or systemic ventricle. Patients with these lesions often develop progressive RV dysfunction over time. This may be related to differences in morphology, genetic profile and hemodynamic exposure between the LV and RV. This review explores the evolutionary and developmental differences between the LV and RV, the molecular basis of these differences and the potential impact of these differences on long term RV adaptation and function in heart disease.