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Anatomy and Pathology of the Tricuspid Valve

  • Chapter
Practical Manual of Tricuspid Valve Diseases

Abstract

The tricuspid valve (TV), the morphologically right atrioventricular valve, guards the inflow junction between the right atrium and right ventricle. In functional anatomy, the valve does not consist only of leaflets. Instead, the valve complex is comprised of the annulus, leaflets, tendinous cords and papillary muscles occupying the inlet part of the right ventricle. Right sided structures have not had the extensive analysis when viewed in comparison to the systemic mitral valve. This is possibly due to the complexity of measuring the geometrically unusual shape of the right ventricular cavity, tricuspid valve, the curvature of the muscular ventricular septum and the right ventricular cavity wrapping around the systemic left ventricle. The route of inflow to outflow in the low pressure right ventricle (RV) is elongated compared to the left side of the heart. The right ventricle itself is an anterior structure forming the sterno-costal border of the heart beneath the sternum. The tricuspid valve is always associated with a morphological right ventricle. The chamber can be arbitrarily demarcated into three regions: inlet, apical and outlet, hence the concept of a tripartite ventricle. But, there are no anatomic borders for these regions within the right ventricle. The inflow region of the tricuspid valve is separated from the outflow pulmonary valve by several muscular structures; the ventricular infundibular fold (VIF), septomarginal trabeculation (SMT), septoparietal trabeculations (SPT) and the free standing subpulmonary infundibulum musculature (Fig. 1.1). Adjacent along the atrial side tricuspid valve complex are important structures like the triangle of Koch, tendon of Todaro, atrioventricular node continuing into the bundle of His and coronary sinus orifice (Fig. 1.2). Continuing improvements of imaging methods such as echocardiography, cardiac magnetic resonance imaging and computed tomography to examine in detail and analyse these structures and to measure the flow of deoxygenated blood to the lungs from the right heart allows critical analysis and on-going follow up of patients in normal and disease states.

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Author information

Authors and Affiliations

  1. Brompton Cardiac Morphology Unit, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK

    Karen P. McCarthy & S. Yen Ho

  2. Histopathology Department, Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK

    Jan Lukas Robertus

Authors
  1. Karen P. McCarthy
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  2. Jan Lukas Robertus
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  3. S. Yen Ho
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Corresponding author

Correspondence to Karen P. McCarthy .

Editor information

Editors and Affiliations

  1. The Thoraxcenter, Erasmus MC: University Medical Center Rotterdam, Rotterdam, The Netherlands

    Osama I. Soliman  & Folkert J. ten Cate  & 

Appendices

Take Home Points

  • The tricuspid valve is not simply the leaflets but a valve complex involving the cords, papillary muscles, annulus and the surrounding musculature.

  • The valve remodels during aging becoming thicker and prone to regurgitation.

  • With numerous scallops, cord attachment and papillary muscle morphology, the tricuspid valve has greater variation than the anatomy of the mitral valve.

Review Questions

  1. 1.

    Which of the following sentences is correct?

    1. (a)

      The tricuspid valve has greater variation than the anatomy of the mitral valve

    2. (b)

      The tricuspid valve has always three clearly identifiable three leaflets as proven on post-mortem studies

    3. (c)

      the tricuspid valve leaflets position is less apical than those of the mitral valve

    4. (d)

      The tricuspid valve is not always associated with a morphological right ventricle.

  2. 2.

    Which of the following sentences is correct?

    1. (a)

      The tricuspid valve leaflets are uniform throughout in structure?

    2. (b)

      The tricuspid valve septal and anterior leaflets are uniform throughout in structure?

    3. (c)

      The tricuspid valve septal and posterior leaflets are uniform throughout in structure?

    4. (d)

      The tricuspid valve leaflets are not uniform throughout in structure?

  3. 3.

    Which of the following sentences is correct?

    1. (a)

      Two of the tricuspid valve papillary muscles are attached to septum

    2. (b)

      Unlike the left heart valves, the tricuspid valve is remote from the pulmonary valve

    3. (c)

      The tricuspid orifice is smaller than the mitral orifice

    4. (d)

      The tricuspid annulus has a near horizontal location

  4. 4.

    Which of the following sentences is correct?

    1. (a)

      The attachment of the tricuspid valve leaflets crosses the atrioventricular node?

    2. (b)

      The attachment of the inferior (posterior) tricuspid valve leaflet is the closest to the atrioventricular node?

    3. (c)

      The attachment of the anterior (anterosuperior) tricuspid valve leaflet is the closest to the atrioventricular node?

    4. (d)

      The attachment of the septal tricuspid valve leaflet is separated by the central fibrous body from the atrioventricular node?

  5. 5.

    Which of the following sentences is correct?

    1. (a)

      The right coronary artery runs in closest proximity to the tricuspid annulus at its initial course.

    2. (b)

      The right coronary artery runs always above to the tricuspid annulus.

    3. (c)

      The right coronary artery runs always below to the tricuspid annulus.

    4. (d)

      There is a gradual shortening of the distance between the right coronary artery and the endocardial surface toward the inferior segment of the annulus to <3 mm.

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McCarthy, K.P., Robertus, J.L., Yen Ho, S. (2018). Anatomy and Pathology of the Tricuspid Valve. In: Soliman, O.I., ten Cate, F.J. (eds) Practical Manual of Tricuspid Valve Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-58229-0_1

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  • DOI: https://doi.org/10.1007/978-3-319-58229-0_1

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-58228-3

  • Online ISBN: 978-3-319-58229-0

  • eBook Packages: MedicineMedicine (R0)

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