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.
Highlights
The right atrioventricular valve (RAV) is an important anatomical structure of the human heart that prevents blood backflow from the right ventricle to the right atrium
Using the attitudinally correct terminology of human anatomy, we identified 4 leaflets: a superior, a septal, a mural and an inferior leaflet [10,14]
To determine the spatial position of the RAV, we described the location of the septal leaflet and its adjacent commissures with respect to selected landmarks within the right atrium
Summary
The right atrioventricular valve (RAV) is an important anatomical structure of the human heart that prevents blood backflow from the right ventricle to the right atrium. RAV regurgitation is common, it is mostly asymptomatic. It is typically diagnosed incidentally or when the pathology has led to severe clinical symptoms [1]. Disorders of the RAV are mainly treated with surgical techniques [2]. These procedures are challenging and have a high risk of complications [2,3,4]. Several promising techniques and devices are currently in development These include the FORMA spacer device, the Trialign device, the Caval Valve Implantation (CAVI), the TriClip device and many others [5,7,8,9]. It is anticipated that minimally invasive procedures will become routine options for patients with contraindications to classical cardiac surgery [6,7]
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