1. Valves

2. Valves Four cardiac valves Two categories One way blood flow
Based on location in heart
Atrioventricular Valves
Mitral and Tricuspid
Semilunar valves
Aortic and Pulmonic

3. Atrioventricular valves
Located between Atria and Ventricles
Diastolic valves-open during diastole
Right Side
Tricuspid valve
Largest of cardiac valves
Three leaflets
Closer to apex
Left Side
Mitral valve
Two leaflets
Smiley face
Diastolic Valves

4. Components of AV Valves
Annulus
Fibrous ring
Superior edge of leaflets
Anchors between atria and ventricles
Leaflets
Made of valvular tissue
Attach to Chordae Tendineae
Chordae Tendineae
Attach to papillary muscles
Papillary Muscles
Anchor the AV valve apparatus to ventricular walls

6. Components of Mitral Valve
Anterior Leaflet
Posterior Leaflet
Commissures
Annulus
Chordae Tendineae

7. Normal Mitral valve

8. Anterior Leaflet Semi-circular shape
Attaches to two fifths of the annular circumference.
Three segments
A1 (anterior segment)
A2 (middle segment)
A3 (posterior segment)
Aortic –mitral curtain
Area of tissue between the mitral vavle and left and non-coronary cusp of aortic valve. (all same tissue)

9. Posterior Leaflet Quadrangular shape and is
Attached to approximately three fifths of the annular circumference.
Two well defined indentations which divides the leaflet into three individual scallops
identified as P1 (anterior or medial scallop),
P2 (middle scallop), and
P3 (posterior or lateral scallop). The three corresponding segments of the anterior leaflet are A1 (anterior segment), A2 (middle segment), and A3 (posterior segment)1. .

10. Commissures
The commissures define a distinct area where the anterior and posterior leaflets come together at their insertion into the annulus.

11. Commisures

12. Annulus Marks the hinge line of the leaflets D shaped
The straight border accommodates the aortic valve
Remember the MV and AoV same tissue so the fibrousness of the annulus is together with AoV too.
This forms right and left trigone. (triangular area of fibrous tissue)
AV node forms in right trigone.

14. Trigones
L trigone
R Trigone

15. Papillary Muscles Normally arise from apex and middle third of LV
Anteriolateral papillary larger
Fed by LAD or left circumflex artery
Posteriomedial papillary smaller
Fed by right coronary artery

16. Chordae Tendineae True False
Small fibrous strings that originate either from the apical portion of the papillary muscles or directly from the ventricular wall and insert into the valve leaflets or the muscle.
False
False chordae can connect 2 papillary muscles, connect a papillary muscle to the ventricular wall, or connect points on the ventricular walls.

17. Tricuspid Valve Three valves Anterior (or infundibular) cusp
Largest Cusp
Between AV orifice and conus arteriosus (LVOT)
Posterior (marginal) Cusp
Next largest
Post to margin of right ventricle
Septal (medial) Cusp
attached to the right and left fibrous trigones and the atrial and ventricular septa.

18. Normal TV

19. Papillary Muscles Anterior, Posterior, Septal Papillary muscles
Anterior- largest
Posterior often bifid or trifid
Septal-smallest
True chordae Tendineae
The true chordae typically originate from the apical third of the papillary muscle but can originate from the ventricular walls, as is the case for the septal leaflet.
True chordae will only connect papillary muscles to leaflets
False Chordae Tendineae
False chordae can connect 2 papillary muscles, connect a papillary muscle to the ventricular wall, or connect points on the ventricular walls.

20. False Chordae (tendon)

21. Semilunar Valves Right Side Left Side Pulmonic valve Aortic valve
Systolic Valves-Open in systole
Made up of 3 pocket- like cusps surrounded by annulus
Smaller than AV valves

23. Pulmonic valves Three Cusps Not supported by septum
Anterior (non septal)
Right
Left
Not supported by septum
Nodes at center of each cusp
In RVOT view the anterior and right cusps can be seen

24. Aortic Valve Three Cusps
right cusp
left cusp
noncoronary cusp
Each cusp has a nodule which when closed meet in the middle
Nodule of Arantius

25. Aortic Sinus Dilation of area just above AoV Three Sinuses
Left Anterior
Rise to left coronary artery
Right Anterior
Rise to right coronary artery
Posterior
No vessels –non coronary sinsus
Also Known As
Sinus of Valsalva
Sinus of Morgani
Sinus of Otto
Petit’s Sinus

26. In Review