Is tricuspid valve really tricuspid?

Abstract

Advancement in imaging techniques and interventional cardiology procedures have generated renewed interest in anatomy of tricuspid valve complex. The purpose of the present study was to characterize the morphology of tricuspid valve leaflets using objective criteria. Thirty-six embalmed cadaveric hearts were utilized for the present study. Leaflet morphology was studied using newly defined criteria. Commissural zones were identified and leaflets were delineated. Presence of scallops was also recorded. Single leaflet was observed in six cases, double in 26 cases, and triple in four cases. The anterior leaflet is large with multiple scallops and frequently accrues portion of inferior leaflet. The septal leaflet is in the form of a plateau and also frequently accrues parts of inferior leaflet. The inferior leaflet rarely occurs as independent leaflet. A wide un-indented basal zone exists across the valve leaflets. The study found that the tricuspid valve is rarely tricuspid. It also generated the hypotheses that the tricuspid valve does not open completely due to presence of a wide basal zone and the valve does not close completely owing to incongruence and lack of coaptation of leaflets. The findings provide clear understanding of leaflet morphology of tricuspid valve. This will help imaging specialists for interpretation of images and cardiologists for interventional procedures. The findings also enhance our understanding of pathophysiology of conditions like functional tricuspid regurgitation.

Redefinition of tricuspid valve structures for successful ring annuloplasty

“…Although this finding is not consistent with the findings reported by Deloche and associates, 11 the region designated the commissural leaflet by those authors was in effect included as part of the posterior leaflet in our study. Athavale and colleagues 13 recently published detailed anatomic studies of the tricuspid valve. They described the inferior (posterior) leaflet as showing variations ranging from an independent leaflet to apportioned with the anterior or septal leaflet completely or partially.…”

Morphological variability of the atrioventricular valve cusps in the equine heart

“…[8][9][10][11][12][13][14][15][16][17][18][19][20][21] Since the advent of cardiac valvular surgery and the development of minimally invasive surgery, in human medicine, the anatomical features of the atrioventricular valves have been the subject of a growing body of literature. [22][23][24][25] On the other hand, in veterinary medicine, morphometrical studies regarding the atrioventricular valves are limited to a few studies carried out on the sheep and the pig, which are used as animal models of valvular disease in humans. [26][27][28] Anatomical studies carried out on the dog 29 and horse 1,30 have documented supernumerary leaflets in the RAV.…”

Gross age-related changes and diseases in human heart valves

“…Tricuspid valve is located between the right atrium and the right ventricle and it is comprised of three leaflets, the anterior, posterior, and septal leaflets, and also the chordae tendinae, the annulus, and the papillary muscles [161821]. In the tricuspid valve, it is more difficult to define the separate leaflets [1618].…”