Detailed Anatomical and Functional Features of the Cardiac Valves
The use of high-resolution noninvasive imaging in modern cardiac clinics to collect detailed images of valve function has dramatically accelerated the understanding of functional human heart anatomy. In the healthy human, the cardiac valves determine the
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Michael G. Bateman, Jason L. Quill, Alexander J. Hill, and Paul A. Iaizzo
Abstract
The use of high-resolution noninvasive imaging in modern cardiac clinics to collect detailed images of valve function has dramatically accelerated the understanding of functional human heart anatomy. In the healthy human, the cardiac valves determine the passage of blood through the heart. The atrioventricular valves open during diastole to allow the filling of the ventricles and close during systole (ventricular contraction), directing blood through the semilunar valves to the body; these valves, in turn, close during diastole to prevent the flow of blood back into the ventricle. By presenting a comprehensive review of the histology, functional anatomy, and morphology of the cardiac valves, this chapter promotes an understanding of the valve features that is required for valvar repair or replacement via either surgical or minimally invasive (transcatheter) means. Keywords
Atrioventricular valve • Semilunar valve • Mitral valve • Tricuspid valve • Aortic valve • Pulmonary valve • Imaging
Abbreviations APM PPM
7.1
Anterior papillary muscle complex (superoposterior) Posterior papillary muscle complex (inferoanterior)
Introduction
A critical understanding of cardiac anatomy is essential for design engineers and clinicians with the intent of developing and/or employing improved or novel technologies or therapies for treating an impaired cardiac valve. Likewise, such M.G. Bateman, PhD (*) • J.L. Quill, PhD • A.J. Hill, PhD Medtronic, Inc., 8200 Coral Sea St. NE, Mounds View, Minneapolis, MN 55112, USA e-mail: [email protected] P.A. Iaizzo, PhD Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
knowledge is required for directing translational research, including initiating preclinical investigations, assessing the feasibility of clinical trials, and performing first-in-man procedures. There are two atrioventricular valves in the human heart, namely, the tricuspid and mitral valves. Likewise, there are two arterial valves in the human heart, specifically the pulmonary and aortic valves. All valves are complex structures whose normal anatomical structure can vary greatly among individuals and/or also become modified by disease processes. In this review, we discuss the anatomy, pathology, and issues related to transcatheter and surgical repairs of the atrioventricular and arterial valves in a translational manner. The high prevalence of aortic valvar pathologies in the burgeoning elderly population, coupled with poor clinical outcomes for patients who go untreated, has resulted in prolific spending in the research and development of more effective and less traumatic therapies. The accelerated development of therapies designed to treat the arterial valves has been guided by anatomical information gathered from highresolution imaging technologies, which in turn have focused attention on the need for complete understanding of arterial valvar clinical anatomies.
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