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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).

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