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.
Bibliographical noteFunding Information:
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.
© 2019 American College of Cardiology Foundation
Copyright 2019 Elsevier B.V., All rights reserved.
- quadricuspid valve
- right atrial appendage
- right atrium
- tricuspid regurgitation
- tricuspid valve
- valve leaflet