Pulmonary Hypertension and the Right Ventricle—Thinking outside the Box (Third International Right Heart Failure Summit, Part 1)

The Third International Right Heart Failure Summit (Boston, MA) convened a group of international clinical and scientific experts in pulmonary vascular disease and right heart disease to explore cutting‐edge developments in the mechanisms and clinical management of right‐sided cardiovascular disease. The symposium was organized into three distinct sessions, the first of which was titled “Pulmonary Hypertension and the Right Ventricle—Thinking outside the Box” and will be the focus of this review. Three internationally renowned experts in pulmonary hypertension and right heart disease—Drs. Stuart Rich, Sean Gaine, and Harm Bogaard—each delivered provocative lectures. The first lecture, by Dr. Rich, was titled “Current Classification for Pulmonary Hypertension—Why Are We Ignoring the Structural Basis of the Disease?” Rich focused on the current classification system of pulmonary hypertension and provided a unique historical perspective. He also addressed the need to evolve the prevailing conceptual framework of our approach to pulmonary vascular diseases and right ventricular dysfunction, including the future design of pulmonary hypertension clinical trials. Dr. Gaine delivered the second lecture, titled “Treatment Algorithm for Pulmonary Hypertension: Tunnel Vision of our Current Approach.” Gaine emphasized the tripartite model of pulmonary hypertension management, namely, supportive measures, pharmacologic therapy, and rescue therapy. Specifically, he detailed how each of these entities is changing as our understanding of the unmet needs in the field of pulmonary hypertension is becoming increasingly apparent. Finally, Dr. Bogaard provided a lecture titled “Treating Right Heart Failure: Why Does the Art of Medicine Lead the Science?” Bogaard provided a stimulating review of cutting‐edge translational research of right ventricular function and dysfunction. In particular, he described a variety of molecular and cellular changes that occur in the hypertrophied right ventricle and contrasted those changes that may be adaptive from those that are maladaptive and may be potential therapeutic targets.