OBJECTIVE Pressure overload of the right ventricle results in right ventricular failure and death. Identifying right ventricular dysfunction at less severe stages, which would allow for more effective intervention, has been limited largely due to complex three-dimensional geometry, complex left ventricular/septum interactions, and lack of accepted approaches to assess regional and organ-level right ventricular function. There have been several recent approaches to better identifying right ventricular dysfunction. Recent advances, particularly in the field of pulmonary arterial hypertension, have highlighted the importance of the right ventricle and rekindled research interest to better understand its adaptation to pressure overload. This review focuses on advances in our understanding of right ventricular adaptation to pressure overload. RESULTS Advances in hemodynamic analysis and imaging the complex three-dimensional right ventricular shape continue to be reported. Additionally, several advances have occurred in our understanding of the pathophysiology of right ventricular adaptation to pressure overload. CONCLUSIONS Imaging and hemodynamic assessments may lead to better identification of right ventricular dysfunction and tools to follow response to treatment. Advances in pathophysiology are beginning to identify several novel treatments that may be of benefit to the failing right ventricle.