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The anatomy and development of the cardiac valves*

Published online by Cambridge University Press:  29 December 2014

Diane E. Spicer ,
Joseph M. Bridgeman ,
Nigel A. Brown ,
Timothy J. Mohun  and
Robert H. Anderson
Diane E. Spicer
Affiliation:
Department of Pediatric Cardiology, University of Florida, Gainesville, Florida, United States of America Congenital Heart Institute of Florida, Saint Petersburg, Florida, United States of America
Joseph M. Bridgeman
Affiliation:
Division of Biomedical Sciences, St George’s University of London, London
Nigel A. Brown
Affiliation:
Division of Biomedical Sciences, St George’s University of London, London
Timothy J. Mohun
Affiliation:
Division of Developmental Biology, MRC National Institute for Medical Research, London
Robert H. Anderson*
Affiliation:
Division of Biomedical Sciences, St George’s University of London, London Institute of Genetic Medicine, Newcastle University, Newcastle, United Kingdom
*
Correspondence to: Professor R. H. Anderson, 60 Earlsfield Road, London SW18 3DN, United Kingdom. Tel: +00 44 20 8870 4368; E-mail: sejjran@ucl.ac.uk
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Abstract

Advances made in the understanding of the molecular biology of the cardiac valves have been truly spectacular. Not all of those investigating these aspects, however, have an appropriate understanding of the underlying anatomy. Partly, this reflects problems in describing the components of the various valves, a difficulty also emphasised by surgeons who repair or replace the valves. In this review, we describe briefly the overall anatomy of the cardiac valves, pointing to their similarities and differences. We then suggest that uniform terms can be developed to account for the components of the valves, treating them as complexes that guard the atrioventricular and ventriculo-arterial junctions. The atrioventricular valvar complex is made up of an annulus, leaflets, tendinous cords, and papillary muscles. The tension apparatus is required to hold the leaflets together against the force of ventricular systole. The ventriculo-arterial complex is also based on the leaflets, but supported within the valvar sinuses, and limited distally by the sinutubular junction. It is the semilunar nature of the leaflets that underscores their snug closure during ventricular diastole. The complexes thus defined can be separated to produce paired valves in the normal arrangement, or to produce common valves in the congenitally malformed hearts. Knowledge of development now permits accurate inferences to be made regarding the origin of the various components, and their relevance to valvar disease. The valvar leaflets are developed from the endocardial cushions formed in the atrioventricular canal and the outflow tract by a process of endothelial-to-mesenchymal transformation. The papillary muscles of the atrioventricular valves are then derived from the trabecular layer of the developing ventricular walls, whereas the sinuses of the ventriculo-arterial valves are formed by additional growth of the non-myocardial tissues, concomitant with excavation of the outflow cushions to form the leaflets.

Keywords

Mitral valvetricuspid valveaortic valvepulmonary valveatrioventricular valves
Type
Original Article
Information
Cardiology in the Young , Volume 24 , Issue 6: HeartWeek 2014 , December 2014 , pp. 1008 - 1022
Copyright
© Cambridge University Press 2014 

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Footnotes

*

Presented at All Children)s Hospital Johns Hopkins Medicine 14th International Symposium on Congenital Heart Disease, Saint Petersburg, Florida, 15--18 February 2014, Special Focus: Diseases of the Cardiac Valves from the Fetus to the Adult, Co-Sponsor: The American Association for Thoracic Surgery (AATS).

References

1.McAlpine, WA. Heart and coronary arteries. An Anatomical Atlas for Clinical Diagnosis, Radiological Investigation, and Surgical Treatment. Springer-Verlag, Berlin, 1975: p. 72.Google Scholar
2.Anderson, RH, Spicer, DE, Hlavacek, AJ, Hill, A, Loukas, M. Describing the cardiac components – attitudinally appropriate nomenclature. J Cardiovasc Transl Res 2013; 6: 118–123.Google Scholar
3.Standring, S. Gray’s Anatomy: The Anatomical Basis of Clinical Practice, 40th edn.. Churchill Livingstone, London, 2008: p. 969.Google Scholar
4.Sievers, HH, Hemmer, W, Beyersdorf, F, et al.The everyday used nomenclature of the aortic root components: the Tower of Babel? Eur J Cardiothorac Surg 2012; 41: 478–482.CrossRefGoogle ScholarPubMed
5.Mohun, TJ, Weninger, WJ. Imaging heart development using high-resolution episcopic microscopy. Curr Opin Genet Dev 2011; 21: 573–578.Google Scholar
6.Cosio, FG, Anderson, RH, Kuck, K. To understand atrial arrhythmias, we need to make nomenclature match anatomy! G Ital Cardiol 1998; 28: 411–415.Google Scholar
7.Cosio, FC, Anderson, RH, Kuck, K, et al.Living anatomy of the atrioventricular junctions. A guide to electrophysiological mapping. A consensus statement from the Cardiac Nomenclature Study Group, Working Group of Arrhythmias, European Society of Cardiology, and the Task Force on Cardiac Nomenclature from NASPE. Circulation 1999; 100: e31–e37.CrossRefGoogle Scholar
8.Perloff, JK, Roberts, WC. The mitral apparatus. Functional anatomy of mitral regurgitation. Circulation 1972; 46: 227–239.Google Scholar
9.Bradlow, WA, Spicer, DE, Anderson, RH. The clinical anatomy of the aortic root, with focus on the enigmatic annulus. Cardiology News 2014; 17: 14–20.Google Scholar
10.Lincoln, J, Garg, V. Etiology of valvular heart disease – genetic and developmental origins. Circ J 2014; 78: 1801–1807.CrossRefGoogle ScholarPubMed
11.Hinton, RB Jr, Lincoln, J, Deutsch, GH, et al.Extracellular matrix remodeling and organization in developing and diseased aortic valves. Circ Res 2006; 98: 1431–1438.Google Scholar
12.Cameron, D. External support of the dilated aorta: back to the future? Heart 2014; 100: 908.Google Scholar
13.Sutton JP III, Ho SY, Anderson, RH. The forgotten interleaflet triangles: A review of the surgical anatomy of the aortic valve. Ann Thorac Surg 1995; 59: 419–427.Google Scholar
14.Person, AD, Klewer, SE, Runyan, RB. Cell biology of cardiac cushion development. Int Rev Cytol 2005; 243: 287–335.Google Scholar
15.Wessels, A, van den Hoff, MJ, Adamo, RF, et al. Epicardially derived fibroblasts preferentially contribute to the parietal leaflets of the atrioventricular valves in the murine heart. Dev Biol 2012; 366: 111–124.Google Scholar
16.Phillips, HM, Mahendran, P, Singh, E, Anderson, RH, Chaudhry, B, Henderson, DJ. Neural crest cells are required for correct positioning of the developing outflow cushions and pattern the arterial valve leaflets. Cardiovasc Res 2013; 99: 452–460.Google Scholar
17.Kanani, M, Moorman, AFM, Cook, AC, et al.Development of the atrioventricular valves: clinicomorphologic correlations. Ann Thorac Surg 2005; 79: 1797–1804.Google Scholar
18.Kramer, TC. The partitioning of the truncus and conus and the formation of the membranous portion of the interventricular septum in the human heart. Am J Anat 1942; 71: 343–370.Google Scholar
19.Anderson, RH, Chaudhry, B, Mohun, TJ, et al.Normal and abnormal development of the intrapericardial arterial trunks in humans and mice. Cardiovasc Res 2012; 95: 108–115.CrossRefGoogle ScholarPubMed
20.Kirby, ML, Gale, TF, Stewart, DE. Neural crest cells contribute to normal aorticopulmonary septation. Science 1983; 220: 1059–1061.Google Scholar
21.Webb, S, Qayyum, SR, Anderson, RH, Lamers, WH, Richardson, MK. Septation and separation within the outflow tract of the developing heart. J Anat 2003; 202: 327–342.Google Scholar
22.Sans-Coma, V, Fernández, B, Durán, AC, et al.Fusion of valve cushions as a key factor in the formation of congenital bicuspid aortic valves in Syrian hamsters. Anat Rec 1996; 244: 490–498.Google Scholar
23.Van Mierop, LH, Patterson, DF, Schnarr, WR. Pathogenesis of persistent truncus arteriosus in light of observations made in a dog embryo with the anomaly. Am J Cardiol 1978; 41: 755–762.Google Scholar
24.Van Praagh, R, Van Praagh, S. The anatomy of common aortic-pulmonary trunk (truncus arteriosus communis) and its embryologic implications. A study of 57 necropsy cases. Am J Cardiol 1965; 16: 406–425.Google Scholar
25.Parisot, P, Mesbah, K, Theveniau-Ruissy, M, Tbx, Kelly RG. Tbx1 subpulmonary myocardium and conotruncal congenital heart defects. Birth Defects Res (Part A) 2011; 91: 477–484.Google Scholar