Higashidate M, Tamiya K, Kurosawa H, Imai Y
Department of Pediatric Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College.
J Thorac Cardiovasc Surg. 1992 Nov;104(5):1212-7.
A septal leaflet of the tricuspid valve is thought to work differently from other anterior and posterior leaflets. We studied its role in valve closure in dogs by means of a dynamic area meter. During the control state, the tricuspid valve orifice area increased twice in diastole coincidentally with either atrial systole or rapid ventricular filling. We observed several findings after the septal leaflet resection: (1) two peak area patterns of the tricuspid valve orifice in diastole, (2) no elevation of right atrial pressure on ventricular systole (there was no V wave), (3) no tricuspid valve regurgitation on right ventriculography. These findings suggest that a complete valve closure occurred without the septal leaflet in regular sinus rhythm. An elevation of the right ventricular pressure produced by pulmonary artery stenosis without septal leaflet, however, easily caused tricuspid valve regurgitation in contrast to the same pressure of the right ventricle with the normal tricuspid valve. The right ventricular pacing caused severe valve regurgitation without the septal leaflet. Results indicate that in the repair of the complete atrioventricular canal defect and other tricuspid valve lesions, the septal leaflet of the tricuspid valve rarely requires attention. An atrioventricular block should be avoided, however, because electrical cardiac pacing on the right ventricle causes severe valve regurgitation without the septal leaflet.
三尖瓣的隔叶被认为其工作方式与其他前叶和后叶不同。我们通过动态面积计研究了其在犬类瓣膜关闭中的作用。在对照状态下，三尖瓣口面积在舒张期增加两倍，与心房收缩或快速心室充盈同时发生。在切除隔叶后，我们观察到了几个结果：（1）舒张期三尖瓣口出现两个峰值面积模式，（2）心室收缩时右心房压力无升高（无V波），（3）右心室造影时无三尖瓣反流。这些结果表明，在正常窦性心律下，没有隔叶时瓣膜也能完全关闭。然而，与具有正常三尖瓣的右心室相同压力相比，无隔叶的肺动脉狭窄导致的右心室压力升高很容易引起三尖瓣反流。右心室起搏在没有隔叶的情况下会导致严重的瓣膜反流。结果表明，在完全性房室通道缺损和其他三尖瓣病变的修复中，三尖瓣的隔叶很少需要关注。然而，应避免房室传导阻滞，因为右心室的心脏电起搏在没有隔叶的情况下会导致严重的瓣膜反流。
