{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T12:14:53Z","timestamp":1788437693056,"version":"build-2803163510"},"reference-count":69,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Pressure overload (PO) and volume overload (VO) represent important mechanisms underlying right ventricular (RV) failure; however, long-term comparative data regarding their distinct pathophysiological consequences remain limited. This study aimed to compare the long-term effects of PO versus VO in a large animal model. Methods: Juvenile sheep were randomly assigned to either a PO group (n = 7) or a VO group (n = 8). PO was induced by pulmonary artery banding, whereas VO was induced by pulmonary leaflet perforation (n = 4) or transannular patch (TAP) reconstruction (n = 4). Both VO procedures resulted in moderate-to-severe pulmonary regurgitation with comparable acute hemodynamic profiles and were therefore analyzed as a single VO group for the long-term assessment. Six animals from each group completed the follow-up period. Animals were evaluated preoperatively and at one-year follow-up using invasive hemodynamic monitoring, blood gas analysis, and echocardiography, followed by postmortem histological analysis of the myocardium. Results: Both models resulted in significant reductions in stroke volume index, cardiac index, RV stroke work index, ScvO2 and tricuspid annular plane systolic excursion (TAPSE). Similarly, the TAPSE\/RV systolic pressure (RVSP) ratio decreased in both groups but was significantly lower in the PO group than in the VO group (p = 0.0022). Moreover, PO showed more pronounced RV diastolic dysfunction, characterized by a significant increase in right atrial pressure from baseline (p = 0.0313) and higher RV diastolic pressure compared to VO (p = 0.0065). In contrast, VO showed a greater impact on left ventricular (LV) geometry and diastolic filling, evidenced by reduced transmitral filling (p = 0.0313) and a lower indexed LV internal diameter compared to PO (p = 0.0411). Histological analysis revealed myocardial hypertrophy and fibrosis in both groups, as well as clusters of multinucleated cardiomyocyte-like cells showing preferential ventricular distribution according to overload physiology. Conclusions: Chronic PO and VO induced distinct phenotypes of RV dysfunction with differential ventricular adaptation and remodelling patterns.<\/jats:p>","DOI":"10.3390\/jcm15176836","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:08:53Z","timestamp":1788433733000},"page":"6836","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-Term Effects of Right Ventricular Pressure and Volume Overload: A Comparative Analysis in an Ovine Model"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2509-3779","authenticated-orcid":false,"given":"Hamida","family":"Al Hussein","sequence":"first","affiliation":[{"name":"Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania"},{"name":"Department of Anesthesiology and Critical Care, Clinical County Hospital Mures, 1 Gheorghe Marinescu Street, 540103 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"given":"Hussam","family":"Al Hussein","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Embryology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania"},{"name":"Regenerative Medicine Laboratory, Center for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania"},{"name":"Department of Cardiovascular Surgery, Emergency Institute for Cardiovascular Diseases and Transplantation, 50 Gheorghe Marinescu Street, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"}]},{"given":"Simina-Elena","family":"Ghiragosian-Rusu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics III, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania"},{"name":"Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation, 50 Gheorghe Marinescu Street, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3968-5118","authenticated-orcid":false,"given":"Simona","family":"Gurzu","sequence":"additional","affiliation":[{"name":"Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania"},{"name":"Research Center of Oncopathology and Translational Research (CCOMT), George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Rita","family":"Szodorai","sequence":"additional","affiliation":[{"name":"Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Carmen","family":"Sircuta","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Emergency Institute for Cardiovascular Diseases and Transplantation, 50 Gheorghe Marinescu Street, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Marius Stefan","family":"Marusteri","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Biostatistics, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"software","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Bogdan","family":"Cordos","sequence":"additional","affiliation":[{"name":"Regenerative Medicine Laboratory, Center for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania"},{"name":"Center of Experimental and Imaging Studies, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9956-2312","authenticated-orcid":false,"given":"David Emanuel","family":"Anitei","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Emergency Institute for Cardiovascular Diseases and Transplantation, 50 Gheorghe Marinescu Street, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Andrei","family":"Atudorei","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Ovidius Clinical Hospital, DN2A km 202 + 880, Ovidiu, 905900 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Sergiu","family":"Crisan","sequence":"additional","affiliation":[{"name":"Center of Experimental and Imaging Studies, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Dan","family":"Simionescu","sequence":"additional","affiliation":[{"name":"Regenerative Medicine Laboratory, Center for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania"},{"name":"Biocompatibility and Tissue Regeneration Laboratory, Department of Bioengineering, Clemson University, Sikes Hall, Clemson, SC 29634, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"given":"Klara","family":"Brinzaniuc","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Embryology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Harvey, W., and Leake, C.D. (1928). Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus, Thomas.","DOI":"10.5962\/bhl.title.6405"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"140","DOI":"10.15420\/cfr.2019.15.2","article-title":"Right Ventricular Failure: Pathophysiology, Diagnosis and Treatment","volume":"5","author":"Arrigo","year":"2019","journal-title":"Card. Fail. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1016\/j.jacc.2018.12.076","article-title":"Anatomy, Function, and Dysfunction of the Right Ventricle","volume":"73","author":"Sanz","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Dayer, N., Ltaief, Z., Liaudet, L., Lechartier, B., Aubert, J.-D., and Yerly, P. (2023). Pressure Overload and Right Ventricular Failure: From Pathophysiology to Treatment. J. Clin. Med., 12.","DOI":"10.3390\/jcm12144722"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.xjon.2025.08.013","article-title":"Right Ventricular Adaptation in Congenital Heart Disease: Does the Type of Right Ventricular Overload Matter?","volume":"28","author":"Joosen","year":"2025","journal-title":"JTCVS Open"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"ytad583","DOI":"10.1093\/ehjcr\/ytad583","article-title":"Right Ventricular to Pulmonary Arterial Coupling in Patients with Repaired Tetralogy of Fallot: A Case Series","volume":"7","author":"Joosen","year":"2023","journal-title":"Eur. Heart J.\u2014Case Rep."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Ribitsch, I., Baptista, P.M., Lange-Consiglio, A., Melotti, L., Patruno, M., Jenner, F., Schnabl-Feichter, E., Dutton, L.C., Connolly, D.J., and Van Steenbeek, F.G. (2020). Large Animal Models in Regenerative Medicine and Tissue Engineering: To Do or Not to Do. Front. Bioeng. Biotechnol., 8.","DOI":"10.3389\/fbioe.2020.00972"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1826","DOI":"10.37358\/RC.19.5.7224","article-title":"Minimally Invasive Surgical Protocol for Adipose Derived Stem Cells Collection and Isolation\u2014Ovine Model","volume":"70","author":"Harpa","year":"2019","journal-title":"Rev. Chim."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"83","DOI":"10.15386\/mpr-2843","article-title":"Umbilical Cord Blood Collection through Elective Cesarean Section in an Ovine Model\u2014A Pilot Study","volume":"98","author":"Harpa","year":"2025","journal-title":"Med. Pharm. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1177\/11297298251382538","article-title":"Preclinical Testing of Acellular and Polyphenol-Stabilized Arterial Xenografts in Sheep","volume":"27","author":"Harpa","year":"2026","journal-title":"J. Vasc. Access"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"104","DOI":"10.37358\/MP.20.2.5356","article-title":"Subcoronary Technique for Orthotopic Implantation of Aortic Scaffold Reinforced with Polytetrafluoroethylene Strips in Sheep: A Pilot Study","volume":"57","author":"Harpa","year":"2019","journal-title":"Mater. Plast."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1177\/039139880903200804","article-title":"Ovine Models for Chronic Heart Failure","volume":"32","author":"Geens","year":"2009","journal-title":"Int. J. Artif. Organs"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1007\/s13770-025-00735-8","article-title":"Short- and Medium-Term Surgical Outcomes of Tissue-Engineered Pulmonary Valve Replacement in Sheep","volume":"22","author":"Suciu","year":"2025","journal-title":"Tissue Eng. Regen. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1007\/s13770-020-00285-1","article-title":"Challenges in Perioperative Animal Care for Orthotopic Implantation of Tissue-Engineered Pulmonary Valves in the Ovine Model","volume":"17","author":"Sircuta","year":"2020","journal-title":"Tissue Eng. Regen. Med."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Movileanu, I., Harpa, M., Al Hussein, H., Harceaga, L., Chertes, A., Al Hussein, H., Lutter, G., Puehler, T., Preda, T., and Sircuta, C. (2021). Preclinical Testing of Living Tissue-Engineered Heart Valves for Pediatric Patients, Challenges and Opportunities. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.707892"},{"key":"ref_16","first-page":"415","article-title":"Pulmonary Heart Valve Replacement Using Stabilized Acellular Xenogeneic Scaffolds; Effects of Seeding with Autologous Stem Cells","volume":"23","author":"Harpa","year":"2015","journal-title":"Rev. Romana Med. Lab."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Al Hussein, H., Al Hussein, H., Harpa, M.M., Ghiragosian, S.E.R., Gurzu, S., Cordos, B., Sircuta, C., Puscas, A.I., Anitei, D.E., and Lefter, C. (2025). Early Outcomes of Right Ventricular Pressure and Volume Overload in an Ovine Model. Biology, 14.","DOI":"10.3390\/biology14020170"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Szodorai, R., Banias, L., Kovalszky, I., Dezs\u0151, K., Kov\u00e1cs, Z., and Gurzu, S. (2024). Gastric-Type Expression Signature in Hepatocellular Carcinoma. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25126588"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1007\/s12265-019-09881-6","article-title":"Right Ventricular Function After Pulmonary Artery Banding: Adaptive Processes Assessed by CMR and Conductance Catheter Measurements in Sheep","volume":"12","author":"Gufler","year":"2019","journal-title":"J. Cardiovasc. Transl. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"H2697","DOI":"10.1152\/ajpheart.2001.281.6.H2697","article-title":"Biventricular Systolic Function in Young Lambs Subject to Chronic Systemic Right Ventricular Pressure Overload","volume":"281","author":"Leeuwenburgh","year":"2001","journal-title":"Am. J. Physiol.-Heart Circ. Physiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2007","DOI":"10.1161\/01.CIR.0000092887.84425.09","article-title":"Effects of Pulmonary Insufficiency on Biventricular Function in the Developing Heart of Growing Swine","volume":"108","author":"Kuehne","year":"2003","journal-title":"Circulation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1510\/icvts.2009.221234","article-title":"Acute and Chronic Response of the Right Ventricle to Surgically Induced Pressure and Volume Overload\u2014An Analysis of Pressure\u2013Volume Relations\u2606","volume":"10","author":"Yerebakan","year":"2010","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.jacc.2012.03.035","article-title":"Acute and Chronic Effects of Dysfunction of Right Ventricular Outflow Tract Components on Right Ventricular Performance in a Porcine Model","volume":"60","author":"Bove","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e70004","DOI":"10.1002\/pul2.70004","article-title":"Non-invasive Surrogates for Right Ventricular-Pulmonary Arterial Coupling: A Systematic Review and Meta-Analysis","volume":"14","author":"Golbin","year":"2024","journal-title":"Pulm. Circ."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"H1625","DOI":"10.1152\/ajpheart.01023.2002","article-title":"Single-Beat Estimation of Right Ventricular End-Systolic Pressure-Volume Relationship","volume":"284","author":"Brimioulle","year":"2003","journal-title":"Am. J. Physiol.-Heart Circ. Physiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1136\/heartjnl-2014-306142","article-title":"RV-Pulmonary Arterial Coupling Predicts Outcome in Patients Referred for Pulmonary Hypertension","volume":"101","author":"Vanderpool","year":"2015","journal-title":"Heart"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1136\/heartjnl-2011-300462","article-title":"Right Ventriculo-Arterial Coupling in Pulmonary Hypertension: A Magnetic Resonance Study","volume":"98","author":"Sanz","year":"2012","journal-title":"Heart"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"H1373","DOI":"10.1152\/ajpheart.00157.2013","article-title":"Tricuspid Annular Plane Systolic Excursion and Pulmonary Arterial Systolic Pressure Relationship in Heart Failure: An Index of Right Ventricular Contractile Function and Prognosis","volume":"305","author":"Guazzi","year":"2013","journal-title":"Am. J. Physiol.-Heart Circ. Physiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/j.jcmg.2016.12.024","article-title":"RV Contractile Function and Its Coupling to Pulmonary Circulation in Heart Failure With Preserved Ejection Fraction","volume":"10","author":"Guazzi","year":"2017","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e002729","DOI":"10.1161\/CIRCHEARTFAILURE.115.002729","article-title":"Impaired Right Ventricular\u2013Pulmonary Arterial Coupling and Effect of Sildenafil in Heart Failure With Preserved Ejection Fraction: An Ancillary Analysis From the Phosphodiesterase-5 Inhibition to Improve Clinical Status And Exercise Capacity in Diastolic Heart Failure (RELAX) Trial","volume":"9","author":"Hussain","year":"2016","journal-title":"Circ. Heart Fail."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.ijcard.2018.01.053","article-title":"Relevance of the TAPSE\/PASP Ratio in Pulmonary Arterial Hypertension","volume":"266","author":"Tello","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2010","DOI":"10.1161\/01.CIR.0000143138.02493.DD","article-title":"Magnetic Resonance Imaging Analysis of Right Ventricular Pressure-Volume Loops: In Vivo Validation and Clinical Application in Patients With Pulmonary Hypertension","volume":"110","author":"Kuehne","year":"2004","journal-title":"Circulation"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1113\/EP085963","article-title":"Maintained Right Ventricular Pressure Overload Induces Ventricular\u2013Arterial Decoupling in Mice","volume":"102","author":"Boehm","year":"2017","journal-title":"Exp. Physiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1093\/ehjci\/jet092","article-title":"Non-Invasive Indices of Right Ventricular Function Are Markers of Ventricular-Arterial Coupling Rather than Ventricular Contractility: Insights from a Porcine Model of Chronic Pressure Overload","volume":"14","author":"Guihaire","year":"2013","journal-title":"Eur. Heart J.\u2014Cardiovasc. Imaging"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1097\/01.CCM.0000257326.96342.57","article-title":"Levosimendan Improves Right Ventriculovascular Coupling in a Porcine Model of Right Ventricular Dysfunction*","volume":"35","author":"Missant","year":"2007","journal-title":"Crit. Care Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"H1054","DOI":"10.1152\/ajpheart.00614.2024","article-title":"Ventriculo-Arterial Coupling in Pulmonary Regurgitation Following Transannular Patch Repair of Pulmonary Stenosis","volume":"328","author":"Zandbergen","year":"2025","journal-title":"Am. J. Physiol.-Heart Circ. Physiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1016\/j.jtcvs.2013.02.039","article-title":"Right Ventricular\u2013Pulmonary Arterial Coupling in Patients after Repair of Tetralogy of Fallot","volume":"146","author":"Latus","year":"2013","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_38","first-page":"914","article-title":"Assessment of Right Ventricular-Pulmonary Arterial Coupling in Chronic Pulmonary Regurgitation","volume":"35","author":"Egbe","year":"2019","journal-title":"Can. J. Cardiol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Nonaka, H., R\u00e4tsep, I., Obonyo, N.G., Suen, J.Y., Fraser, J.F., and Chan, J. (2024). Current Trends and Latest Developments in Echocardiographic Assessment of Right Ventricular Function: Load Dependency Perspective. Front. Cardiovasc. Med., 11.","DOI":"10.3389\/fcvm.2024.1365798"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1093\/ejechocard\/jep209","article-title":"The Influence of Pulmonary Regurgitation on Regional Right Ventricular Function in Children after Surgical Repair of Tetralogy of Fallot","volume":"11","author":"Eyskens","year":"2010","journal-title":"Eur. J. Echocardiogr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1016\/j.echo.2013.06.022","article-title":"Tricuspid Annular Plane Systolic Excursion in the Assessment of Right Ventricular Function in Children and Adolescents after Repair of Tetralogy of Fallot","volume":"26","author":"Parnell","year":"2013","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"I-212","DOI":"10.1161\/CIRCULATIONAHA.104.517789","article-title":"Right Atrial and Ventricular Adaptation to Chronic Right Ventricular Pressure Overload","volume":"112","author":"Gaynor","year":"2005","journal-title":"Circulation"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"H1350","DOI":"10.1152\/ajpheart.00782.2001","article-title":"Indexes of Diastolic RV Function: Load Dependence and Changes after Chronic RV Pressure Overload in Lambs","volume":"282","author":"Leeuwenburgh","year":"2002","journal-title":"Am. J. Physiol.-Heart Circ. Physiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1378\/chest.06-1263","article-title":"Right Ventricular Diastolic Dysfunction and the Acute Effects of Sildenafil in Pulmonary Hypertension Patients","volume":"132","author":"Gan","year":"2007","journal-title":"Chest"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2016","DOI":"10.1161\/CIRCULATIONAHA.113.001873","article-title":"Right Ventricular Diastolic Impairment in Patients With Pulmonary Arterial Hypertension","volume":"128","author":"Rain","year":"2013","journal-title":"Circulation"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"H354","DOI":"10.1152\/ajpheart.00180.2013","article-title":"Distinct Loading Conditions Reveal Various Patterns of Right Ventricular Adaptation","volume":"305","author":"Borgdorff","year":"2013","journal-title":"Am. J. Physiol.-Heart Circ. Physiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1183\/09031936.00156714","article-title":"Clinical Relevance of Right Ventricular Diastolic Stiffness in Pulmonary Hypertension","volume":"45","author":"Trip","year":"2015","journal-title":"Eur. Respir. J."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"855","DOI":"10.3727\/096368909X471170","article-title":"Autologous Umbilical Cord Blood Mononuclear Cell Transplantation Preserves Right Ventricular Function in a Novel Model of Chronic Right Ventricular Volume Overload","volume":"18","author":"Yerebakan","year":"2009","journal-title":"Cell Transplant."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"H1314","DOI":"10.1152\/ajpheart.00776.2012","article-title":"Physiologic and Molecular Characterization of a Murine Model of Right Ventricular Volume Overload","volume":"304","author":"Reddy","year":"2013","journal-title":"Am. J. Physiol.\u2014Heart Circ. Physiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.ijcard.2017.04.021","article-title":"Is the Presence of End-Diastolic Forward Flow Specific for Restrictive Right Ventricular Physiology in Repaired Tetralogy of Fallot?","volume":"240","author":"Mori","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1016\/j.ijcard.2012.04.008","article-title":"Determinants and Functional Impact of Restrictive Physiology after Repair of Tetralogy of Fallot: New Insights from Magnetic Resonance Imaging","volume":"167","author":"Lee","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e024036","DOI":"10.1161\/JAHA.121.024036","article-title":"End-Diastolic Forward Flow and Restrictive Physiology in Repaired Tetralogy of Fallot: A Systematic Review and Meta-Analysis","volume":"11","author":"Derdeyn","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1111\/echo.14113","article-title":"Diastolic Dysfunction in Tetralogy of Fallot: Comparison of Echocardiography with Catheterization","volume":"35","author":"DiLorenzo","year":"2018","journal-title":"Echocardiography"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1093\/cvr\/cvx160","article-title":"The Overloaded Right Heart and Ventricular Interdependence","volume":"113","author":"Naeije","year":"2017","journal-title":"Cardiovasc. Res."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e299","DOI":"10.1016\/j.jtcvs.2021.07.040","article-title":"Influence of Right Ventricular Pressure and Volume Overload on Right and Left Ventricular Diastolic Function","volume":"163","author":"Jani","year":"2022","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1510\/icvts.2009.227264","article-title":"A Novel Porcine Model for Right Ventricular Dilatation by External Suture Plication of the Pulmonary Valve Leaflets\u2014Practical and Reproducible\u2606","volume":"10","author":"Agger","year":"2010","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1002\/ame2.12124","article-title":"Establishment of Adult Right Ventricle Failure in Ovine Using a Graded, Animal-Specific Pulmonary Artery Constriction Model","volume":"3","author":"Liu","year":"2020","journal-title":"Anim. Model. Exp. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"753210","DOI":"10.1155\/2015\/753210","article-title":"Novel Model of Pulmonary Artery Banding Leading to Right Heart Failure in Rats","volume":"2015","author":"Hirata","year":"2015","journal-title":"BioMed Res. Int."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"H1204","DOI":"10.1152\/ajpheart.00246.2014","article-title":"Characterization of Right Ventricular Remodeling and Failure in a Chronic Pulmonary Hypertension Model","volume":"307","author":"Aguero","year":"2014","journal-title":"Am. J. Physiol.-Heart Circ. Physiol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"e00184","DOI":"10.1002\/phy2.184","article-title":"Progressive Right Ventricular Functional and Structural Changes in a Mouse Model of Pulmonary Arterial Hypertension","volume":"1","author":"Wang","year":"2013","journal-title":"Physiol. Rep."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1002\/ejhf.931","article-title":"Volume Load-induced Right Ventricular Dysfunction in Animal Models: Insights in a Translational Gap in Congenital Heart Disease","volume":"20","author":"Bossers","year":"2018","journal-title":"Eur. J. Heart Fail."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1177\/0363546505274714","article-title":"Muscle Injuries: Biology and Treatment","volume":"33","author":"Kalimo","year":"2005","journal-title":"Am. J. Sports Med."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Aguilar-Garc\u00eda, D., Fern\u00e1ndez-Sarmiento, J.A., Del Mar Granados Machuca, M., Rodr\u00edguez, J.M., Rasc\u00f3n, P.M., Calvo, R.N., Ruiz, Y.M., Poveda, J.M.C., Casta\u00f1eda, J.M., and Bertomeu, R.C. (2022). Histological and Biochemical Evaluation of Plasma Rich in Growth Factors Treatment for Grade II Muscle Injuries in Sheep. BMC Vet. Res., 18.","DOI":"10.1186\/s12917-022-03491-2"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Zhao, M.-T., Ye, S., Su, J., and Garg, V. (2020). Cardiomyocyte Proliferation and Maturation: Two Sides of the Same Coin for Heart Regeneration. Front. Cell Dev. Biol., 8.","DOI":"10.3389\/fcell.2020.594226"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.ijcard.2011.02.022","article-title":"Myocardial Hypertrophy after Pulmonary Regurgitation and Valve Implantation in Pigs","volume":"159","author":"Smith","year":"2012","journal-title":"Int. J. Cardiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1940","DOI":"10.1161\/CIRCULATIONAHA.119.043530","article-title":"Homotypic Fusion Generates Multinucleated Cardiomyocytes in the Murine Heart","volume":"141","author":"Ali","year":"2020","journal-title":"Circulation"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1186\/s10020-026-01486-5","article-title":"Cardiomyocyte Fusion Contributes to Cardiac Hypertrophy in Adult Hearts","volume":"32","author":"Colliva","year":"2026","journal-title":"Mol. Med."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1016\/j.jacc.2010.08.648","article-title":"Right Ventricular Failure Following Chronic Pressure Overload Is Associated With Reduction in Left Ventricular Mass","volume":"57","author":"Hardziyenka","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e004436","DOI":"10.1161\/CIRCHEARTFAILURE.117.004436","article-title":"Pulmonary Effective Arterial Elastance as a Measure of Right Ventricular Afterload and Its Prognostic Value in Pulmonary Hypertension Due to Left Heart Disease","volume":"11","author":"Tampakakis","year":"2018","journal-title":"Circ. Heart Fail."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6836\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:27:18Z","timestamp":1788434838000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6836"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":69,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176836"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176836","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]}}}