Buckberg Gerald, Hoffman Julien I E
Department of Cardiothoracic Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif.
Department of Pediatrics and Cardiovascular Research Institute, University of California, San Francisco, School of Medicine, San Francisco, Calif.
J Thorac Cardiovasc Surg. 2014 Dec;148(6):3166-71.e1-4. doi: 10.1016/j.jtcvs.2014.05.044. Epub 2014 May 21.
The right ventricle (RV) is composed of a free wall containing a wrap-around circumferential muscle at its base and a septum composed of helical fibers that are oblique and cross each other at 60° angles. This structure is defined by the helical ventricular myocardial band and defines RV function because the wrap-around transverse fibers constrict or compress to cause the bellows motion responsible for 20% of RV output, whereas the oblique fibers determine shortening and lengthening that produces 80% of RV systolic function. Clinical shortening is quantified by tricuspid annular plane systolic excursion and measured by echocardiography. Destruction of the free wall by electrocautery or patch replacement does not alter RV function if the septum is intact. Conversely, septal damage causes RV dysfunction if pulmonary vascular resistance is increased. The interaction between structure and function to cause RV failure and how these factors become corrected is defined for RV failure, RV relationship to LV failure, resynchronization, pacing, RV dysplasia, left ventricular assist device, intraoperative septal injury during myocardial protection, the septal role in tricuspid insufficiency, pharmacologic decisions on altering pulmonary vascular resistance in RV failure, congenital heart disease, and adult heart disease is considered in this overview. These structure-function relationships emphasize why clinical decisions must be based on knowledge of normality, recognizing how disease offsets normality, and introducing actions that rebuild normality.
右心室（RV）由一个在其基部含有环绕圆周肌的游离壁和一个由螺旋纤维组成的隔膜构成，这些螺旋纤维呈倾斜状且相互交叉成60°角。这种结构由螺旋状心室心肌带所界定，并决定了右心室的功能，因为环绕的横向纤维收缩或压缩会引起风箱样运动，负责20%的右心室输出，而倾斜纤维则决定缩短和延长，产生80%的右心室收缩功能。临床缩短通过三尖瓣环平面收缩期位移来量化，并通过超声心动图进行测量。如果隔膜完整，电灼或补片置换对游离壁的破坏不会改变右心室功能。相反，如果肺血管阻力增加，隔膜损伤会导致右心室功能障碍。本综述考虑了导致右心室衰竭的结构与功能之间的相互作用以及这些因素如何得到纠正，右心室与左心室衰竭的关系、再同步化、起搏、右心室发育异常、左心室辅助装置、心肌保护期间的术中隔膜损伤、隔膜在三尖瓣关闭不全中的作用、右心室衰竭时改变肺血管阻力的药物决策、先天性心脏病和成人心脏病。这些结构 - 功能关系强调了为什么临床决策必须基于对正常状态的了解，认识到疾病如何偏离正常状态，并引入重建正常状态的行动。
