Pearls - The RV is recognized by its morphological features and not by its location (e.g. in ccTGA, the RV is on the left) -If a shunt is suspected and not demonstrated on TTE, pursue contrast imaging or magnetic resonance imaging   - Always assess coronary anatomy if a patient is deteriorating or before a corrective surgery e.g. in TOF or TGA post arterial switch Always exclude associated congenital heart defects   - Atrial arrhythmias or ventricular tachycardia often indicate severe hemodynamic compromise and should lead to further assessment - Always consider protein losing enteropathy in the presence of hypoalbuminemia   - Close monitoring of patients with RV failure is needed to find the proper window for surgery (cf. table on indications) Pitfalls - Never attempt to close a septal defect in the presence of severe  “irreversible” PH - Never manage complex congenital cases without referral  to a regional referral center of CHD   - Avoid maximal exercise testing in a patient with severe PH and RV failure (context of ASD or VSD) - Avoid cardiac catheterization in patients with mild disease or if surgery is not planned.

Table 1: Pearls and Pitfalls in managing in Managing CHD with Right Heart Failure.