Right Ventricular Remodeling in Adult Congenital Heart Disease: a Clinician Perspective

Tarinee Tangcharoen
Assistant Professor


The number of adult population with congenital heart disease has been increasing significantly due to improvement of surgical technique in childhood. However, even patients who underwent successfully surgical repair of congenital defects, the exercise performance and survival are still below normal individuals. Unlike the adult patients with acquired heart disease whom the left ventricle is an independent prognosis factor, the right ventricle (RV) plays an important role in this group of patients. Many right heart parameter measurements ,such as right heart volume and function, have been associated with adverse clinical outcome in adult congenital heart disease (ACHD) patients. Right ventricular remodeling, especially the changes in right ventricular volume and function, has been observed in various types of ACHD. Recent studies have also shown that myocardial deformation such as right ventricular strains can detect early changes in ventricular function before the changes in ejection fraction. Myocardial texture alteration, defined as myocardial fibrosis, has also been associated with myocardial dysfunction and exercise intolerance in ACHD patients. Although echocardiography is the first-line imaging modality in adult patients, it has limited role in right heart imaging due to acoustic window. Cardiovascular magnetic resonance (CMR) has many advantages over echocardiography. CMR is a gold standard for both right heart volume and functional evaluation. Diffuse myocardial fibrosis in both left and right ventricle can be quantified by the T1-mapping technique CMR. For myocardial deformation, Feature tracking CMR (FT-CMR) is a novel semi-automated post-processing technique which can detect right heart strain and can be performed on acquired images. Because CMR is a versatile imaging modality, its role for RV remodeling measurement in adult congenital heart disease and its clinical importance in this group of patients are of great interest.