Pulmonary atresia is a complex congenital heart defect with marked morphological and clinical heterogeneity. Central to this variability is the embryological development of the right ventricle (RV) and its subcomponents. This review explores the embryological basis of RV development, emphasizing the bipartite and tripartite configurations and their clinical relevance in pulmonary atresia. Recent advances in human embryology, including high-resolution reconstructions from the Human Developmental Biology Resource (HDBR) and the work of Hikspoors and colleagues, provide an updated framework for understanding RV morphogenesis 1-2. We highlight how disruption of ventricular partitioning, mural hypertrophy, and conotruncal malalignment contribute to the phenotypic spectrum of pulmonary atresia 3-4. Finally, we examine the impact of RV morphology on surgical strategy and long-term prognosis.

Cardiomyopathies represent a heterogeneous group of myocardial diseases characterized by structural and functional abnormalities that can lead to heart failure, arrhythmias, and sudden cardiac death. Echocardiography remains the first-line, non-invasive imaging modality for the evaluation of cardiomyopathies, owing to its broad availability, safety profile, and diagnostic versatility. This review comprehensively outlines the echocardiographic features associated with the major morphofunctional subtypes of cardiomyopathy: dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), restrictive cardiomyopathy (RCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and left ventricular non-compaction cardiomyopathy (LVNC). Emphasis is placed on both adult and pediatric populations, with attention to age-specific diagnostic criteria and measurement standards. The article also includes structured tabular summaries to facilitate clinical interpretation and application across diverse patient settings. Through an integrated and standardized echocardiographic approach, this review aims to support accurate diagnosis, effective monitoring, and informed therapeutic decision-making in the management of cardiomyopathies.

The right ventricle (RV) possesses a complex geometry and unique functional characteristics stemming from its embryologic development. Unlike the left ventricle (LV), which arises primarily from the primary heart field, the RV originates predominantly from the anterior or secondary heart field, influencing its structural organization, myocardial fiber orientation, and contractile patterns. This embryologic origin is not only essential for understanding congenital anomalies but also profoundly impacts the interpretation and accuracy of echocardiographic modalities used to assess RV function. This review explores how knowledge of RV embryology enhances the clinical application of echocardiographic methods, including tricuspid annular plane systolic excursion (TAPSE), tissue Doppler imaging (TDI), RV fractional area change (FAC), 3D echocardiography, and RV longitudinal strain. Incorporating embryologic insights provides a more anatomically and physiologically grounded approach to evaluating RV performance, especially in congenital heart disease and right heart failure.

The management of pulmonary atresia with intact ventricular septum (PA/IVS) or critical pulmonary stenosis (CPS) in neonates continues to evolve, with a growing emphasis on individualized care based on right ventricular (RV) morphology. This commentary discusses and expands upon the recent study by Moras et al., which proposes echocardiographic classification of RV morphology—tripartite versus bipartite—as a predictive tool for post-intervention complications and a guide for intensive care management following transcatheter RV decompression. Integrating developmental cardiac anatomy, the commentary highlights how structural differences in RV segmentation influence physiological responses. Tripartite RVs are often susceptible to left ventricular (LV) dysfunction due to a sudden preload shift following decompression, requiring early inotropic support and delayed feeding strategies. In contrast, bipartite RVs are predisposed to dynamic outflow tract obstruction, often managed with beta-blockers and possible surgical shunting. The discussion also addresses the surgical versus catheter-based treatment decision in light of anatomical constraints such as RV-dependent coronary circulation and monopartite RVs. Additionally, the commentary reviews echocardiographic modalities used to assess RV function both prenatally and postnatally, including TAPSE, tissue Doppler imaging, myocardial performance index, and speckle-tracking echocardiography. It concludes by suggesting that early RV morphotype identification and function monitoring, even in fetal life, may enhance prognostication and therapeutic planning. This commentary advocates for a developmentally informed, phenotype-driven approach to neonatal cardiac care that bridges structural diagnosis with functional management.