Anatomical evaluation of a novel echocardiography based tricuspid valve classification in 60 hearts from body donors

Abstract

Abstract OBJECTIVES This study aimed to provide comprehensive morphological descriptions of the morphology of the tricuspid valve and to evaluate if a novel echocardiography-based tricuspid valve nomenclature can also be understood anatomically. METHODS Tricuspid valves of 60 non-embalmed human body donors without a medical history of pathologies or macroscopic malformations of the heart were included. Length, height and surface area of leaflets were measured. The valves were morphologically classified according to a novel echocardiography-based classification, in which 6 types are distinguished: classic 3-leaflet configuration, bicuspid valves, valves with 1 leaflet split into 2 scallops or leaflets and valves with 2 leaflets divided into 2 scallops or leaflets. RESULTS We found a true 3-leaflet configuration in only 19 (31.7%) of valves. Five (8.3%) had a 2-leaflet configuration with a fused anterior and posterior leaflet. Of those, 3 had a divided septal leaflet. Four valves (6.7%) had a divided anterior leaflet, 17 (28.3%) had a divided posterior leaflet, 6 (10%) had a divided septal leaflet and 9 (15.0%) had 2 leaflets divided. Overall, 39 (65%) of valves have at least 1 leaflet that is divided. In 22 (36.7%) specimens, the leaflet was divided into true leaflets, and in 17 (28.3%) specimens, the leaflet was divided into scallops. In addition, we could identify 9 (15%) valves having 1 leaflet divided not only in 2 but 3 scallops or leaflets. CONCLUSIONS This study provides further anatomical insight for the significant variability in the morphology of the tricuspid valve. By updating the understanding of its morphological characteristics, this study equips clinicians with valuable insights to effectively advance surgical and interventional treatment of tricuspid valves.