The normal anatomy and physiology of the right ventricle is reviewed in order to understand its dysfunction. Right ventricular failure may occur because of pulmonary artery hypertension or right ventricular ischemia. Use of intraoperative transesophageal echocardiographic techniques, myocardial protection, new approaches to coronary artery bypass, new pharmacological treatments, and mechanical assist support may modify the outcome of patients with right ventricular failure.