Nagarathnamma B, Manjunath Ashok Koganoli. Tricuspid valve morphometry - In cadaveric study.
IAIM, 2018; 5(12): 66-
71.
Original Research Article
Tricuspid valve morphometry - In
cadaveric study
Nagarathnamma B1*, Manjunath Ashok Koganoli2
1
Assistant Professor, Department of Anatomy, JJM Medical College, Davangere, Karnataka, India
2 rd
3 year MBBS Student, JJM Medical College, Davangere, Karnataka, India
*
Corresponding author email:
[email protected] International Archives of Integrated Medicine, Vol. 5, Issue 12, December, 2018.
Copy right © 2018, IAIM, All Rights Reserved.
Available online at http://iaimjournal.com/
ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)
Received on: 01-11-2018 Accepted on: 05-12-2018
Source of support: Nil Conflict of interest: None declared.
How to cite this article: Nagarathnamma B, Manjunath Ashok Koganoli. Tricuspid valve
morphometry - In cadaveric study. IAIM, 2018; 5(12): 66-71.
Abstract
Background: The tricuspid valve is situated between the right atrium and the right ventricle. This
valve prevents back flow of blood from the right ventricle to right atrium. For cardiovascular
surgeons, the morphometry of tricuspid valve is of clinical importance.
Aim: To study the tricuspid valve morphometry in cadavers.
Materials and methods: This study was conducted on 120 adult human hearts, whose age was
ranging from 21 to 66 years, as decomposition or putrefaction might occur during medico-legal post-
mortem examination which was performed within nineteen hours of death so that the morphology and
morphometry of the heart was not altered. From the total number 30 hearts had accessory leaflets and
scallops in tricuspid valve.
Results: : The weight of heart (g), circumference of tricuspid valve (mm), attachment length of
leaflets and commissures (mm), height of three leaflets (mm) were the parameters which were
studied. Between the circumference of tricuspid valve with the weight of heart, attachments lengths of
leaflets and the three commissures and leaflets height, a direct correlation was observed.
Conclusion: This study can be used as an important tool in anthropological studies, which was
performed to improve analysis of the morphometric parameters of tricuspid valve and to correlate the
various parameters and which further helped the cardiac surgeons and forensic experts to understand
the anatomy of the tricuspid valve complex and appropriate design of valvular complex for
transplantation.
Key words
Tricuspid valve, Anteroseptal Commissure, Septo-posterior Commissure, Posteroanterior
Commissure.
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Introduction parameters were studied. After cleaning the
The right atrio-ventricular valve is the largest of hearts under tap water, the hearts were dissected
all the valves of the heart. The term atrio- with least destruction of valves. The right atrium
ventricular valve apparatus or complex is more was opened, the first incision was given from
apt from a functional standpoint [1]. Tricuspid right aspect of inferior vena cava and to the
valve diseases are common in persons with superior vena cava. Along the inferior border of
pulmonary hypertension and intravenous drug the heart, the second incision was given to the
abusers and may be congenital or acquired [2]. inferior margin of anterior inter-ventricular
The most common anomaly of the tricuspid groove along the acute margin of the heart. Right
valve is the Ebstein’s anamoly. The most to the anterior interventricular groove, the third
common one in use is the trans-catheter therapies incision was made. Retraction of the walls
for mitral regurgitation. In rare cases, parallel carefully and the inferior was washed under tap
percutaneous approaches for tricuspid water thoroughly to remove clots. Shape of the
regurgitation is needed. For differentiating tricuspid valve was observed. At the junction of
between functional and organic tricuspid anterior and posterior leaflet, the tricuspid valve
diseases, the knowledge of the morphology and was opened by cutting the annulus. The heart
morphometry of the tricuspid valve is needed was washed thoroughly. With a clean cloth,
accurately [3]. In human beings, the tricuspid excessive water was soaked. Morphometric
valve does not lie in single line and its position parameters measured are weight of heart,
and structural complexity adds to the challenges circumference of tricuspid valve, leaflets length,
in its assessment by radiological techniques [4, anterior leaflet, septal leaflet, posterior leaflet,
5]. To restore the original mechanics of the attachment length of commissures. The weight of
valvular complex in order to maintain the heart was recorded by using electronic weighing
circulation naturally after repair of the diseased balance. The number of cusps of tricuspid valve
valve is the major task of cardio-surgeons. With and their position was noted. The lengths of all
interventional cardiology progressing rapidly, parameters were measured using non-strechable
study of morphometric measures of tricuspid surgical silk thread. The thread was straightened
valve complex on cadavers is the important need and the length was measured by metric ruler with
of time. readability of 0.5 mm (Figures – 1 to 4). The
results were computed and statistically analysed
with SPSS software 16. P-value was calculated
Materials and methods
by Pearson’s correlation coefficient and analysed
This study was conducted on 120 adult human as >0.05 was considered as statistically
hearts, whose age was ranging from 21 to 66 insignificant, <0.05 was considered as
years, as decomposition or putrefaction might statistically significant, <0.01 was considered as
occur during medico-legal post-mortem statistically highly significant and <0.001 was
examination which was performed within considered as statistically extremely significant.
nineteen hours of death so that the morphology
and morphometry of the heart is not altered. The
Results
hearts which are having evidence of any disease,
decomposed or burnt, which are injured before or Table - 1 shows that the morphometric
during autopsy were not included in the study. parameters were calculated like average weight
From the total 120 of hearts studied, 30 hearts in grams was 259.87±33.74, the circumference in
had anatomical variation of one or more type in mm was 95.25±11.48, average attachment length
the leaflets structure and they were excluded. in mm i.e. the septal leaflet was the largest
There were accessory leaflets and scallops in amongst the three leaflets which was 29.44±5.77.
tricuspid valve in the 30 hearts. The hearts were Average of ASC, SPC and PAC was 7.54±4.53.
placed back in the dead body after the desired
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Nagarathnamma B, Manjunath Ashok Koganoli. Tricuspid valve morphometry - In cadaveric study. IAIM, 2018; 5(12): 66-
71.
Figure - 1: Methods of Measurements of Circumference and attachment length of tricuspid valve
leaflets with surgical Silk thread.
Figure - 2: Tricuspid Valve. Figure - 4: Weighing machine used for the study.
Table - 2 shows that weight of heart and
circumference of tricuspid valve was extremely
significant with a p value of <0.001. Attachment
Figure - 3: Tricuspid Valve Complex. length of anterior leaflet and circumference of
tricuspid valve was insignificant with a p value
of >0.05, attachment length of septal leaflet and
circumference of tricuspid valve was extremely
significant with a p value of <0.001, attachment
length of posterior leaflet and circumference of
tricuspid valve was extremely significant with a
p value of <0.001.
Table - 3 shows that attachment length of ASC
and circumference of tricuspid valve was highly
significant with a p value of <0.01, attachment
length of SPC and circumference of tricuspid
valve was extremely significant with a p value of
<0.001, attachment length of PAC and
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Nagarathnamma B, Manjunath Ashok Koganoli. Tricuspid valve morphometry - In cadaveric study. IAIM, 2018; 5(12): 66-
71.
circumference of tricuspid valve was highly valve was insignificant with a p value of >0.05
significant with a p value of <0.01. and height of posterior leaflet and circumference
of tricuspid valve was extremely significant with
Table - 1: Morphometric parameters. a p value of <0.001.
Sr. Morphometric
No parameters Table - 3: Pearson’s correlation coefficient
1. Average Weight (gms) 259.87±33.74 between parameters and their p-value.
2. Circumference (mm) 95.25±11.48 Attachment length of commissure and
3. Ratio C/Wt 0.327±0.05 Circumference of tricuspid valve
4. Average attachment length (mm) ASC 0.415 <0.01 Highly
a) Anterior Leaflet 26.87±6.88 significant
b) Septal Leaflet 29.44±5.77 SPC 0.528 <0.001 Extremely
c) Posterior Leaflet 23.07±9.21 significant
d) ASC 5.64±2.45 PAC 0.389 <0.01 Highly
e) SPC 9±3.67 significant
f) PAC 5.91±2.11
g) Average 7.54±4.53 Table - 4: Pearson’s correlation coefficient
(ASC+SPC+PAC) between parameters and their p-value.
ASC: Anteroseptal Commissure Height of leaflet and Circumference of
SPC: Septo-posterior Commissure tricuspid valve
PAC: Posteroanterior Commissure Anterior 0.399 <0.05 Significant
Leaflet
Table - 2: Pearson’s correlation coefficient Septal Leaflet - >0.05 Insignificant
between parameters and their p-value. 0.038
Morphomet Pearson’s P- significance Posterior 0.526 <0.001 Extremely
ric Correlati Value Leaflet significant
parameters on
Coefficie Discussion
nt Out of 120 hearts of present study, the anterior
Weight of 0.634 <0.001 Extremely average attachment length of leaflet of tricuspid
heart and significant valve was 26.87±6.88 mm, the septal average
Circumferen attachment length of leaflet was 29.44±5.77 mm
ce of and the posterior average attachment length of
tricuspid leaflet was 23.07±9.21 mm, where as in
Attachment length of leaflet and Circumference of Motabagani, et al. study [6], the anterior average
tricuspid valve attachment length of tricuspid valve leaflet was
Anterior 0.1792 >0.05 Insignificant the highest with 43.60±3.40 mm, the septal
Leaflet average attachment length of leaflet was
Septal 0.5218 <0.001 Extremely 33.20±3.30 mm and the posterior average
Leaflet attachment length of leaflet was 29.20±2.80. In
Posterior 0.479 <0.001 Extremely Skwarek, et al. study [7], similar to the present
Leaflet study, the septal average attachment length of
leaflet was the highest, the anterior average
Table - 4 shows that height of anterior leaflet attachment length of leaflet was 31.98±8.74 mm,
and circumference of tricuspid valve was the septal average attachment length of leaflet
significant with a p value of <0.05, height of was 32.16±8.79 mm and the posterior average
septal leaflet and circumference of tricuspid attachment length of leaflet was 24.10±9.08. In
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Nagarathnamma B, Manjunath Ashok Koganoli. Tricuspid valve morphometry - In cadaveric study. IAIM, 2018; 5(12): 66-
71.
Antoniali, et al. study [8], the the septal average including 23 patients with atrial septal defect.
attachment length of leaflet was 30.6±3.7 mm. In Left ventricular function (n=20) and right
the present study, average weight in grams was ventricular function (n=10) were also assessed
259.87±33.74, the circumference in mm was using dedicated software.
95.25±11.48 and C/wt ratio was 0.327±0.05mm,
whereas in Skwarek, et al. [7] study, Conclusion
circumference was 105.67±16.76, in Antoniali, et This study can be used as an important tool in
al. [8] study, average weight in grams was anthropological studies, which was performed to
355.55±65.30, the circumference in mm was improve analysis of the morphometric
105±12.7 and C/wt ratio was 0.303±0.05 mm. In parameters of tricuspid valve and to correlate the
present study, average of ASC, SPC and PAC various parameters and which further helped the
was 7.54±4.53 whereas in Skwarek, et al. study cardiac surgeons and forensic experts to
[7], average of ASC, SPC and PAC was understand the anatomy of the tricuspid valve
6.42±2.23. In present study, ASC was 5.64±2.45 complex and appropriate design of valvular
mm, SPC was 9±3.67 mm and PAC was complex for transplantation.
5.91±2.11 mm, whereas in Anwar, et al. [4, 5]
study, ASC was 5.4±1.5 mm, SPC was 5.2±1.5
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