HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University, Kraków, Poland; Department of Cardiac and Vascular Diseases, Jagiellonian University, Kraków, Poland.
Visible Heart Laboratory, Departments of Biomedical Engineering and Surgery, University of Minnesota, Minneapolis, Minnesota.
JACC Cardiovasc Interv. 2019 Jan 28;12(2):169-178. doi: 10.1016/j.jcin.2018.09.029.
The authors aimed to comprehensively detail the right atrioventricular valve functional leaflet anatomies.
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.
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.
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.
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.
作者旨在全面详细描述右房室瓣功能瓣叶解剖结构。
三尖瓣反流的外科和经皮修复技术的快速发展重新引起了人们对右房室瓣形态变异的兴趣。
使用可见心脏方法对 40 个再灌注人心的功能正常的右房室瓣进行成像。然后对心脏进行灌注固定和解剖，独特之处在于可以从同一组供体心脏中比较评估功能瓣和固定瓣的解剖结构。
右房室瓣在 57.5%的心脏中呈“三瓣叶”结构，在其余心脏中呈“四瓣叶”结构。对于四瓣叶瓣，在瓣环的最下区域通常观察到额外的瓣叶。两种瓣型的瓣周径无差异（112.2 毫米对 117.1 毫米；p=0.14）。在三叶瓣中，隔瓣、壁瓣和上瓣分别占据瓣环的 32.2±6.5%、15.9±5.5%和 25.5±6.2%，而在四叶瓣中，这些值分别为 27.0±5.8%（隔瓣）、12.0±4.5%（下叶）、13.7±9.4%（壁瓣）和 19.8±6.1%（上叶）。房室中隔-隔叶和房室下-隔叶交界通常位于三尖瓣隔叶区，而房室下-壁叶和房室上-壁叶交界位于右心耳前庭区。
右房室瓣在超过 40%的情况下具有 4 个功能瓣叶。作者发现，房室下壁区域是瓣叶最可变的区域，认为解剖变异是计划干预的重要考虑因素。
