Survivorship into adulthood of patients with congenital heart disease is due to improvements in prenatal detection, novel surgeries, and specialized adult congenital heart disease care. As patients survive further into adulthood, long-term complications of congenital and repaired physiology have been more clearly elucidated. The overall mortality of patients with adult congenital heart disease with heart failure is around 4%. Congenital malformations, palliations, residual defects, and resultant physiology impact the right ventricle. This relationship influences morbidity and mortality. For this discussion, focus on atrial septal defects, Ebstein anomaly, Tetralogy of Fallot, transposition of the great vessels, and single right ventricle physiology.