Morphology and Position of the Right Atrioventricular Valve in Relation to Right Atrial Structures

Abstract

The right atrioventricular valve (RAV) is an important anatomical structure that prevents blood backflow from the right ventricle to the right atrium. The complex anatomy of the RAV has lowered the success rate of surgical and transcatheter procedures performed within the area. The aim of this study was to describe the morphology of the RAV and determine its spatial position in relation to selected structures of the right atrium. We examined 200 randomly selected human adult hearts. All leaflets and commissures were identified and measured. The position of the RAV was defined. Notably, 3-leaflet configurations were present in 67.0% of cases, whereas 4-leaflet configurations were present in 33.0%. Septal and mural leaflets were both significantly shorter and higher in 4-leaflet than in 3-leaflet RAVs. Significant domination of the muro-septal commissure in 3-leflet valves was noted. The supero-septal commissure was the most stable point within RAV circumference. In 3-leaflet valves, the muro-septal commissure was placed within the cavo-tricuspid isthmus area in 52.2% of cases, followed by the right atrial appendage vestibule region (20.9%). In 4-leaflet RAVs, the infero-septal commissure was located predominantly in the cavo-tricuspid isthmus area and infero-mural commissure was always located within the right atrial appendage vestibule region. The RAV is a highly variable structure. The supero-septal part of the RAV is the least variable component, whereas the infero-mural is the most variable. The number of detected RAV leaflets significantly influences the relative position of individual valve components in relation to right atrial structures.

The Right Coronary Anatomy and Operative Topography of the Tricuspid Valve Annulus

“…Analyzing the results will help avoid the fatal complications of RCA damage such as arrhythmias and hemodynamic instability in the peri- and postoperative period after tricuspid annuloplasty. Previous measurements of the TVA and RCA were mainly conducted in 2D planes and cadaver labs with smaller samples [ 2 , 13 , 17 , 18 ]. As far as the authors are concerned, there was only one proposition of the TVA topographic description based on measurements conducted by 3D segmented models up to this date.…”

“…RCA deviation should be considered to prevent damage to an exceptionally localized artery, especially in the case of atrial RCA deviation due to the needle course when suturing from the atrial side and the invisibility of the site where the needle is pulled out. Cases of RCA injury were reported in DeVega annuloplasty (4), ring annuloplasty (4), and band annuloplasty (2). Two RCA occlusions were reported as a complication of a minimally invasive approach.…”

“…The normal tricuspid valve is the largest human heart valve that usually has three leaflets (the number can vary from two to seven) [ 1 , 2 ]. It is surrounded by a fibrous, saddle-shaped tricuspid valve annulus (TVA) that separates the right atrium (RA) and the right ventricle (RV) from the myocardium.…”