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Mixed venous oxygen content is the oxygen content of blood after the returning venous streams have mixed, representing whole-body venous return to the right side of the heart. It is the venous quantity required with arterial oxygen content in the whole-body Fick principle. A single regional vein need not have this content: different tissues remove different amounts of oxygen and return different blood flow rates.

The mixing rule follows from conservation of mass. If streams have blood flow rates $Q_i$ and venous oxygen content values $C_i$, with no oxygen exchange during mixing,For two constructed streams, $100$ mL/min at $0.05$ mL of oxygen per mL of blood and $50$ mL/min at $0.20$ mL/mL carry $5$ and $10$ mL/min of oxygen. Their mixture has content $15/150=0.10$ mL/mL, not the unweighted mean $0.125$ mL/mL. The correct weights are volume blood flow rates.

The right atrium receives several returns before blood passes through the right ventricle and pulmonary trunk.^[ref] A downstream sample can represent their mixture only to the extent that the streams have actually mixed and the sampling interval represents the desired state. Replacing that sample with one taken from a particular upstream vein introduces a representativeness assumption. Likewise, averaging oxygen saturation values is not generally an oxygen-content balance when hemoglobin concentrations differ. The whole-body balance is about amounts of transported oxygen, not averages of instrument displays.

The pulmonary trunk is the common artery leaving the right ventricle through the pulmonary valve before dividing into the vessels supplying the two lungs. It is the initial shared segment of the pulmonary artery route in the pulmonary circulation. The name artery describes flow away from the heart; the blood in the pulmonary trunk has not yet acquired oxygen in the lungs.^[ref]

At a junction with negligible storage, conservation of mass givesA constructed total blood flow of $5$ L/min could therefore divide into $3$ and $2$ L/min. Measuring the total does not establish equal flow to the two lungs. In a simple steady model with a common upstream and downstream pressure, branch blood flow rates depend on their respective vascular resistance values; the shared inlet does not force the resistances to be equal.

The pulmonary trunk also supplies an important distinction between two measurements. Right ventricular ejection fraction describes change in a chamber volume, whereas forward blood flow in the pulmonary trunk describes transport through a vessel. They agree through stroke volume and heart rate only under the relevant balance assumptions, including negligible backward flow. An anatomical connection is therefore the starting point for a flow model, rather than a substitute for its assumptions.

The pulmonary valve is the heart valve between the right ventricle and pulmonary trunk. During forward ventricular ejection it allows blood to enter the pulmonary circulation; closure limits return from the pulmonary trunk into the relaxing right ventricle.^[ref]

Its pocket-like cusps respond to the changing pressure difference. Unlike the tricuspid valve, the pulmonary valve has no attached chordae tendineae or papillary muscles.^[ref] Thus the same direction-control task is achieved by different supporting structures at the chamber inlet and outlet.

A deliberately idealized valve model sets forward blood flow to zero when the downstream pressure exceeds the upstream pressure, and permits positive flow when ventricular pressure exceeds trunk pressure. This model captures direction but omits the inertia and deformation of real cusps. It is useful for checking the sign of a flow term, not for predicting an exact opening time.

For example, if a constructed cycle sends 80 mL forward and 10 mL backward across the pulmonary valve, net transport is 70 mL. Counting only the positive part of blood flow overestimates net delivery. This is why stroke volume inferred from changing chamber volume and net forward flow in the pulmonary trunk require compatible assumptions about valve function.

A pulmonary vein returns blood from a lung to the left atrium. The pulmonary veins complete the return side of the pulmonary circulation, after blood has received oxygen in the lungs. They are veins because they carry blood toward the heart, even though their oxygen content is higher than that of the blood arriving through the pulmonary artery.^[ref]

Following a parcel of blood makes the sequence clear: right ventricle, pulmonary trunk, vessels of the lungs, pulmonary vein, left atrium, then left ventricle. The pulmonary vein connects the lung circuit to the receiving chamber of the left heart; it does not drain directly into the right atrium.

A simple oxygen balance illustrates why both content and flow matter. Suppose two returning streams have blood flow rates $Q_1,Q_2$ and oxygen contents $C_1,C_2$. If they mix without further oxygen exchange, the left atrium's inflow content isFor constructed values $Q_1=3$ L/min, $Q_2=2$ L/min, $C_1=0.20$ and $C_2=0.15$ mL/mL, this gives $0.18$ mL/mL. An unweighted average would give $0.175$ mL/mL. A specimen's vessel connections establish where the streams meet; conservation of mass establishes how their transported oxygen combines.

The right ventricle is the heart chamber receiving blood from the right atrium through the tricuspid valve and ejecting it through the pulmonary valve into the pulmonary trunk.^[ref] Its output enters the pulmonary circulation rather than passing directly into the aorta.

The chamber's volume changes through the cardiac cycle. Define stroke volume as end-diastolic minus end-systolic volume:The second ratio is the right ventricular ejection fraction. In an original example with $V_{\mathrm{ED}}=100\mathrm{mL}$ and $V_{\mathrm{ES}}=40\mathrm{mL}$, stroke volume is $60\mathrm{mL}$ and ejection fraction $0.60$. At $70$ beats per minute, multiplying stroke volume by rate gives $4.2\mathrm{L}\mathrm{mi}{\mathrm{n}}^{-1}$.

That last conversion represents net forward output only under its stated assumptions. Significant backward or alternate flow can separate chamber-volume displacement from the amount delivered onward. Nor does an ejection fraction alone provide the chamber's absolute output: chambers with different initial volumes can share the same fraction.

In a steady serial-circulation model without shunts or sustained storage, right- and left-sided net outputs must balance. A persistent difference would accumulate blood somewhere in the system. This conservation statement does not require the two ventricles to generate equal pressure or perform identical mechanical work. Anatomy, volume displacement, forward flow and pressure are distinct but connected observations.

Right ventricular ejection fraction is the fraction of the right ventricle's end-diastolic volume that leaves its cavity during systole. If $V_{\mathrm{ED}}$ is the filled volume and $V_{\mathrm{ES}}$ the residual end-systolic volume,where $\mathrm{SV}$ is stroke volume. It is a dimensionless ratio, usually reported as a percentage. The filling and ejection phases must refer to the same cardiac cycle; the tricuspid valve and pulmonary valve determine the normal direction of blood flow.^[ref]

For example, $V_{\mathrm{ED}}=120$ mL and $V_{\mathrm{ES}}=60$ mL give $\mathrm{SV}=60$ mL and $\mathrm{RVEF}=50\%$. A second right ventricle with volumes 200 and 100 mL also has $50\%$ right ventricular ejection fraction, but its stroke volume is 100 mL. A fraction describes emptying relative to the initial volume; it does not specify an absolute cardiac output.

A practical volumetric approach uses magnetic resonance imaging at multiple phases and image segmentation to estimate the two cavity volumes.^[ref] Consistent boundary choices matter because two measurements enter one ratio. For small volume errors, direct differentiation givesShared boundary errors need not act like independent errors. Moreover, cavity volume loss includes any backward flow through an incompetent tricuspid valve; the formula alone does not prove that all of the calculated stroke volume reached the pulmonary trunk.