Author + information
- Received April 16, 2018
- Revision received August 20, 2018
- Accepted September 18, 2018
- Published online January 21, 2019.
- Mateusz K. Hołda, MD, PhDa,b,∗ (, )
- Jorge D. Zhingre Sanchez, MScc,
- Michael G. Bateman, PhDc,d and
- Paul A. Iaizzo, PhDc,d
- aHEART–Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University, Kraków, Poland
- bDepartment of Cardiac and Vascular Diseases, Jagiellonian University, Kraków, Poland
- cVisible Heart Laboratory, Departments of Biomedical Engineering and Surgery, University of Minnesota, Minneapolis, Minnesota
- dInstitute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
- ↵∗Address for correspondence:
Dr. Mateusz K. Hołda, HEART–Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034 Cracow, Poland.
Objectives The authors aimed to comprehensively detail the right atrioventricular valve functional leaflet anatomies.
Background The rapid development of both surgical and percutaneous repair techniques for tricuspid regurgitation has renewed interest in variations in the morphology of the right atrioventricular valve.
Methods The functioning right atrioventricular valves of 40 reanimated human hearts were imaged using Visible Heart methodologies. Hearts were then perfusion-fixed and dissected, uniquely allowing for the comparative assessments of functional versus fixed valve anatomies from the same set of donor hearts.
Results The right atrioventricular valves have “3-leaflet” configurations in 57.5% and “4-leaflet” configurations in the remaining hearts. For 4-leaflet valves, extra leaflets were commonly observed in the most inferior regions of the annuli. No difference in valve perimeters between 2 valve types were observed (112.2 vs. 117.1 mm; p = 0.14). In 3-leaflet valves, septal, mural, and superior leaflets occupied 32.2 ± 6.5%, 15.9 ± 5.5%, and 25.5 ± 6.2% of the annulus, respectively, whereas in the 4-leaflet arrangements, these values were 27.0 ± 5.8% (septal), 12.0 ± 4.5% (inferior), 13.7 ± 9.4% (mural), and 19.8 ± 6.1% (superior). The muroseptal/inferoseptal commissures were usually located in the cavotricuspid regions, whereas the inferomural and superomural commissures were in the right atrial appendage vestibule area.
Conclusions The right atrioventricular valve has 4 functional leaflets in more than 40% of cases. The authors found that the inferomural region is the most variable area of the valve and believe that anatomic variation is an important consideration for planned interventions.
- tricuspid valve
- quadricuspid valve
- right atrial appendage
- right atrium
- tricuspid regurgitation
- valve leaflet
Dr. Hołda was supported by the Foundation for Polish Science (FNP) and National Science Centre, Poland (NCN) (2017/01/X/NZ4/00690). The Visible Heart Laboratory was supported in part by the Institute for Engineering in Medicine, by the Lillihei Heart Institute, and through a research contract with Medtronic. The authors have received research funding from Medtronic.
- Received April 16, 2018.
- Revision received August 20, 2018.
- Accepted September 18, 2018.
- 2019 American College of Cardiology Foundation
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