In the research paper conducted by Dr. Shiina and colleagues, they aim to evaluate the right ventricular diastolic energy loss (EL) as a cardiac load in adult patients with pulmonary atresia with intact ventricular septum (PAIVS), and its association with major adverse cardiovascular events (MACE).
The study concludes that in adult patients with PAIVS, not only the size of the right ventricle, but also pre-load and after-load could potentially increase the load on the right heart.

Yumi Shiina, Kei Inai, Keiichi Itatani, Eriko Shimada, Michinobu Nagao , "Increased Diastolic Energy Loss Associated with Cardiac Events in Adults with Pulmonary Atresia Suffering from Intact Ventricular Septum", Magnetic Resonance in Medical Sciences, July 20, 2024 (2024) https://doi.org/10.2463/mrms.mp.2023-0130.