Newly Published
Images in Anesthesiology  |   August 2019
Right Ventricular Dysfunction and the “D”-shaped Left Ventricle
Author Notes
  • From the Division of Cardiovascular Anesthesiology, Texas Heart Institute, Baylor St. Luke’s Medical Center; and the Department of Anesthesiology, Baylor College of Medicine, Houston, Texas.
  • Correspondence: Address correspondence to Dr. Ma: chrismma88@gmail.com
Article Information
Images in Anesthesiology / Cardiovascular Anesthesia
Images in Anesthesiology   |   August 2019
Right Ventricular Dysfunction and the “D”-shaped Left Ventricle
Anesthesiology Newly Published on August 30, 2019. doi:10.1097/ALN.0000000000002961
Anesthesiology Newly Published on August 30, 2019. doi:10.1097/ALN.0000000000002961
Transesophageal echocardiography images were acquired from a 70-yr-old patient with pulmonary hypertension and heart failure. The left image depicts leftward deviation of the interventricular septum during diastole, a phenomenon suggestive of right ventricular (RV) volume overload. The right image portrays interventricular septum (IVS) flattening during systole, a finding characteristic of right ventricular pressure overload. Together, these transgastric midpapillary short-axis images capture the classic echocardiographic finding of a “D”-shaped left ventricle (LV) secondary to septal flattening in the setting of right ventricular dysfunction.
Since both ventricles share the interventricular septum and pericardium, a phenomenon known as ventricular interdependence exists where dysfunction of one ventricle impacts the function of the other. Normally, the interventricular septum is concave towards the left ventricle throughout the cardiac cycle, contributing to proper biventricular function. In right ventricular pressure or volume overload states, interventricular septum flattening can mechanically alter left ventricle geometry and impair left ventricle function.2  Therefore, it is imperative that right ventricular dysfunction be identified and treated early.1