Right Atrioventricular Valve Leaflet Morphology Redefined: Implications for Transcatheter Repair Procedures

Mateusz K. Hołda, Jorge D. Zhingre Sanchez, Michael G. Bateman, Paul A. Iaizzo

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


Objectives: The authors aimed to comprehensively detail the right atrioventricular valve functional leaflet anatomies. Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)169-178
Number of pages10
JournalJACC: Cardiovascular Interventions
Issue number2
StatePublished - Jan 28 2019

Bibliographical note

Funding Information:
Dr. Hołda was supported by the Foundation for Polish Science (FNP) and National Science Centre, Poland (NCN) (2017/01/X/NZ4/00690). The Visible Heart Laboratory was supported in part by the Institute for Engineering in Medicine, by the Lillihei Heart Institute, and through a research contract with Medtronic. The authors have received research funding from Medtronic.

Publisher Copyright:
© 2019 American College of Cardiology Foundation

Copyright 2019 Elsevier B.V., All rights reserved.


  • quadricuspid valve
  • right atrial appendage
  • right atrium
  • tricuspid regurgitation
  • tricuspid valve
  • valve leaflet


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