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The scope of this review is to provide a pathophysiological summary of perioperative right ventricular function and failure. In recent decades, the importance of right ventricular function in the perioperative period has been established. However, much of our current knowledge on the management of this clinical entity is based on extrapolation of results from left ventricular research, although biventricular physiology is known to be markedly different in many aspects. Here, on the basis of a thorough literature search, we review theoretical as well as practical aspects of perioperative right ventricular failure. After underlining the importance of this topic, we review basic right ventricular anatomy and physiology, with an emphasis on the role of ventricular interaction. Next, potential causes of perioperative right ventricular failure are discussed. The emphasis of this review is on the perioperative anaesthetic considerations, ranging from preoperative assessment through intraoperative monitoring to specific contemporary therapeutic options of perioperative right ventricular failure.