The morphology of the right atrioventricular valve in the adult human heart

Studies of the morphometry and normal anatomy of the tricuspid valve are in constant demand. Knowledge of the morphology of the normal tricuspid valve may be useful, for example in the context of the transfer of a leaflet of the tricuspid valve for repair or insufficiency of the mitral valve, in repair of the tricuspid valve after blunt chest trauma and in other surgical techniques of this region. In this study, performed in a group of 107 formalin-fixed adult human hearts, we attempted to assess the form and number of the main and accessory cusps in the tricuspid valve. Rare anatomical variants of the tricuspid valve were found. Using a planimeter we evaluated the surface area of the tricuspid valve and particular leaflets. With the help of a Vernier scale we measured the length and height of individual leaflets of the tricuspid valve and the length of the commissures. No differences were found between the length of the anterior and septal leaflets. The posterior leaflet was the shortest, while the anterior leaflet was the widest and had the largest surface area. The posterior leaflet was wider than the septal leaflet and had the smallest surface area. No differences were found between the main and accessory leaflets in the length of the commissures

Basic axes of human heart in correlation with heart mass and right ventricular wall thickness

A comparison of the data published in anatomy textbooks and anthropological tables does not reveal any change in basic heart dimensions during the period since the beginning of the 20th century to nowadays. However, normal values of many other parameters have changed up to 30% over the same period. These changes may be caused by the acceleration phenomenon or the extension of average lifespan. The progress of laboratory medicine methodology permitted the introduction of new biochemical tests in myocardial infarct diagnosis, such as myoglobin and troponins T and I measurement, as well as better understanding of cardiac metabolism. Parameters describing the direction and intensity of metabolic changes are substrate extraction and metabolic equilibrium. The expression describing metabolic equilibrium contains heart mass value. Therefore, as studying heart mass in vivo is not possible, it may be important to study it in vitro. The study was performed on a group of 107 formalin-fixed human hearts. The organs came from adults of both sexes: 30 women and 77 men, aged 18 to 90 years. None of the hearts carried signs of macroscopic developmental abnormalities or pathologic changes

Notes on the morphology of the tricuspid valve in the adult human heart

Rapid progress in the field of interventional cardiology has caused research in the field of morphometry of the heart to be in constant demand [7–10, 12]. In this study, performed on a group of 75 adult human hearts, the authors have attempted to assess the form and number of the main and accessory cusps in the tricuspid valve. We have classified particular forms into 8 groups, depending on the number of cusps and we have divided the cusps into 3 main groups, depending on the support of the chordae tendineae

The connection between the papillary muscles and leaflets of the tricuspid valve

The tricuspid valve is more differentiated during evolutionary development than the mitral valve. In birds it is a muscular structure joined directly to the papillary muscles, although the mitral valve of birds resembles that of mammals. There have been well-known studies describing the evolutionary line of connection of the tricuspid valve with the papillary muscles. The present study was performed on a group of 107 formalin-fixed adult human hearts. The valves and papillary muscles were classified according to a scheme for human hearts drawn up earlier. The types of connection between leaflets of the tricuspid valve and the papillary muscles were classified according to a scheme drawn up earlier for vertebrates. We observed 3 types of connection between leaflets of the tricuspid valve and the papillary muscles in the group studied. The muscular and membranous connections were not linked with any one type of tricuspid valve. Atypical forms of distribution of the tendinous chords of the right ventricle were observed. It was found that valves with a higher number of leaflets were (with the exception of type 0) provided with a smaller number of tendinous chords. Atavistic features and atypical forms of distribution of the tendinous chords are present in a small percentage of samples of the human right valvular apparatus

Positions of septal papillary muscles in human hearts

Septal papillary muscles, similarly to other papillary muscles, are essential elements of the heart valvular system. Damage to their structure may lead to a considerable life risk. Of all the papillary muscles, the septal papillary muscles are characterized by the greatest topographical and morphological variability. However, information about these muscles is scarce and fragmentary. The objective of this study was to ascertain their occurrence and the region in which they are placed in the inter-ventricular septum. One hundred and eleven human hearts were examined. The hearts belonged to the Clinical Anatomy Department of the Medical University of Gdańsk. They were fixed in formalin with ethanol and came from middle-aged and older individuals of both sexes, devoid of pathological changes and birth defects. During the tests, classic anatomical methods were applied. The region where the papillary muscles are found covers a sizeable surface of the septum, from the conus arteriosus up to the back angle of the right chamber. Depending on their location the following septal papillary muscles (musculi papillares septales, MPS) were singled out: 1) lying on the front wall of the septum (anterior papillares septales), 2) in the central part of the septum (central muscles), and 3) in the posterior section of the septum (posterior papillares septales). A trial to determine the types of MPS was based on this diversity of location. Consequently, five types of MPS were specified: type I: anterior-central (44.1%); type II: anterior (15.3%); type III: anterior-posterior (13.5%); type IV: anterior-central-posterior (24.3%); and type V: uniform (2.75%). This study is an attempt to systematize and standardize the terminology of these structures. (Folia Morphol 2010; 69, 2: 101-106

Microscopic study of right fibrous annulus

The term annulus fibrous is still used in anatomical and clinical terminology but does not exist in anatomical nomenclature. This structure is proposed as an anatomical substrate for circus movement of excitation. Multiple cardiac damage after blunt chest trauma is rare, but usually affects the septal part of the right fibrous annulus. Histological observation confirms the results of our previous macroscopic study and shows that the most stable part of fibrous annulus is the septal part and the region of anterior angle of the right ventricle, and the most labile parts are the lateral and posterior angles of the right ventricle and the posterior part of the fibrous annulus. Our histological study shows that the right fibrous annulus is a heterogeneous structure and may play a role in changes of shape of the right atrio-ventricular ostium during human life

The morphology and distribution of the tendinous chords and their relation to the papillary muscles in the tricuspid valve of the human heart

The tendinous chords of the tricuspid valve are the predominant type of connection between the papillary muscles and the tricuspid valve. Studies describing the evolutionary line of these connections are well known. The flexibility of particular leaflets of the tricuspid valve varies, as does the tension of the blood stream in particular cusps. The present study was performed on a group of 96 formalin-fixed adult human hearts, which ranged in age from 18 to 90 years and gave no evidence of congenital malformations or pathological changes. The valves were divided into five types according to earlier studies and analysis was made in terms of these types. The tendinous chords and their ramifications were counted. The surfaces of particular leaflets were measured. The ratio of marginal to ventricular leaflets was counted for each type of leaflet in particular types of valves. The parts of the main leaflets supported by specific papillary muscles were counted for types 1, 2 and 3. The number of tendinous chords decreased in leaflets in particular types of tricuspid valve, but the ratio of chords attached to the margins and ventricular surfaces was similar. The number of chords for the surface of leaflets (measured in mm2) was similar in particular types of valve for all cusps. The most differentiated were commissural chords in all types of valve. The ratio of chords attached to the margins and ventricular surfaces does not depend on the surface area of the leaflets

The relationship between the membranous part of the interventricular septum and the septal part of the attachment of the tricuspid valve in adult human hearts

The membranous septum is a difficult structure to demonstrate in vivo. It is possible to measure its dimensions in a cadaver after the introduction of light into the aorta, but difficult to do so otherwise. The present study was performed on a group of 107 formalin-fixed adult hearts from both sexes and 18-90 years of age. The hearts were divided into groups depending on sex and age. The length of the septal part of the attachment of the tricuspid valve was divided by the length of the supravalvular part of the membranous interventricular septum

Septomarginal trabecula and anterior papillary muscle in primate hearts: developmental issues

The septomarginal trabecula is present in all human hearts as well as in thehearts of other primates. It usually connects the interventricular septum withthe anterior papillary muscle, although there are many variations in how this isachieved. The object of the analyses was to estimate the bilateral topography ofthe septomarginal trabecula and the anterior papillary muscle in the context ofthe ontogeny and phylogeny of primates. A total of 138 hearts were examinedfrom number of different non-human primates. The presence of the septomarginaltrabecula was confirmed in 94.9% of cases, although not in the hearts ofLemur varius. Four configurations could be distinguished by defining the locationof the septomarginal trabecula and its relation to the anterior papillary muscle.For the hearts of the Strepsirrhini and the majority of Platyrrhini neither structurewas related, whereas in all examined representatives of Hominoidea they hadfused and created morphologically varying forms. On the basis of these results,a concept was developed for the sequence of changes which the topography ofthe septomarginal trabecula and the anterior papillary muscle undergo duringontogeny and phylogeny

Morphometric features of the right atrioventricular orifice in adult human hearts

The normal data of the tricuspid valve complex is of great clinical importance in the light of progress in cardiosurgery and the development of novel operating techniques. A range of measurements for the right atrioventricular orifice in 96 human adult hearts was examined by means of anatomical dissection, inspection, examination, and statistical analyses. The length of the attachment of the anterior leaflet increased significantly between group I (aged 18-40 years) and group II (aged 41-64 years) in women only. In men there were no significant differences in this parameter between any of the three age groups. In addition, the attachment length of the posterior leaflet in women increased statistically in the second age group. In men, in contrast, the attachment length of the posterior leaflet did not increase significantly between the first and second age groups and became significantly larger only in oldest age group, consisting of men aged over 65. No statistically significant differences between the three age groups were found for the attachment length of the septal leaflet (p > 0.05). In female hearts significant increases in the frontal and sagittal dimensions of the tricuspid valve orifice were observed between the second age group and the group aged over 65. In male hearts both the frontal and sagittal dimensions increased significantly with advanced age. The right atrioventricular orifice expressed as the ellipse area was statistically greater than the triangular area (p < 0.01) in each age group. It should be noticed that both areas increased significantly during ageing. This study has demonstrated that the shape of the right atrioventricular orifice evolves during life, from a triangular shape to a more elliptical shape. (Folia Morphol 2008; 67: 53-57