(Circulation. 1995;91:111-121.)
© 1995 American Heart Association, Inc.
Articles |
Formation of the Tricuspid Valve in the Human Heart
From the Department of Anatomy and Embryology, Academic Medical Center, University of Amsterdam (W.H.L., A.W., A.F.M.M.); the Department of Pathology, Postgraduate Medical School, Budapest (S.V.); and the Department of Paediatrics, National Heart and Lung Institute, London (R.H.A.).
Correspondence to Wouter H. Lamers, Department of Anatomy and Embryology, Academic Medical Center, Meibergdreef 15, 1105 AZ, Amsterdam, the Netherlands.
Background Some of the problems concerning the origin of the inlet component of the definitive right ventricle were resolved in a previous study in which we showed it to be derived exclusively from the embryonic right ventricle. Questions remain, however, concerning the relative contributions of endocardial cushion tissue and myocardium to the definitive valvar apparatus guarding the right atrioventricular orifice and the origin of the valvar leaflets.
Methods and Results The formation of the tricuspid valve was studied by scanning electron microscopic and immunohistochemical techniques. Concurrent with the development of the right atrioventricular connection, a myocardial ridge forms at the boundary between the atrioventricular canal and the embryonic right ventricle. It grows to become a myocardial gully that funnels atrial blood beneath the lesser curvature of the initial heart tube toward the middle of the right ventricle. Fenestrations in the floor of the gully create an additional inferior opening in the funnel, transforming its initial anterior rim into the septomarginal trabeculation. The septum formed by the fusion of the endocardial ridges of the outflow tract becomes myocardialized in its inferior portion to form, in part, the outlet septum and, in part, the supraventricular crest. The smooth atrial surface of the tricuspid valvar leaflets develops from endocardial cushion tissue. The leaflets become freely movable, however, only after delamination of the tension apparatus within the myocardium. The inferior and septal leaflets derive from the gully and the ventricular septum, their delamination being a single, continuous process. The anterosuperior leaflet forms by delamination from the developing supraventricular crest.
Conclusions The leaflets of the tricuspid valve develop equally from the endocardial cushion tissues and the myocardium. The myocardium contributing to the valve comes from two sources, the tricuspid gully complex and the developing supraventricular crest. These findings facilitate the understanding of several congenital malformations.
Key Words: ventricles • endocardium • conduction • morphogenesis • myocardium
This article has been cited by other articles:
 |
|
 |
|
  C. H. Attenhofer Jost, H. M. Connolly, J. A. Dearani, W. D. Edwards, and G. K. Danielson Ebstein's Anomaly Circulation, January 16, 2007; 115(2): 277 - 285. [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Chauvaud, A. C. Hernigou, E. R. Mousseaux, D. Sidi, and J.-L. Hebert Ventricular Volumes in Ebstein's Anomaly: X-Ray Multislice Computed Tomography Before and After Repair Ann. Thorac. Surg., April 1, 2006; 81(4): 1443 - 1449. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Kanani, A. F.M. Moorman, A. C. Cook, S. Webb, N. A. Brown, W. H. Lamers, and R. H. Anderson Development of the Atrioventricular Valves: Clinicomorphological Correlations Ann. Thorac. Surg., May 1, 2005; 79(5): 1797 - 1804. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. J. de Lange, A. F.M. Moorman, R. H. Anderson, J. Manner, A. T. Soufan, C. d. G.-d. Vries, M. D. Schneider, S. Webb, M. J.B. van den Hoff, and V. M. Christoffels Lineage and Morphogenetic Analysis of the Cardiac Valves Circ. Res., September 17, 2004; 95(6): 645 - 654. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Wessels and D. Sedmera Developmental anatomy of the heart: a tale of mice and man Physiol Genomics, November 11, 2003; 15(3): 165 - 176. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. F. M. MOORMAN and V. M. CHRISTOFFELS Cardiac Chamber Formation: Development, Genes, and Evolution Physiol Rev, October 1, 2003; 83(4): 1223 - 1267. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. H Anderson, S. Webb, N. A Brown, W. Lamers, and A. Moorman Development of the heart: (2) Septation of the atriums and ventricles Heart, August 1, 2003; 89(8): 949 - 958. [Full Text] [PDF]
|
|
|
|
|
|
D. L. Brutsaert Cardiac Endothelial-Myocardial Signaling: Its Role in Cardiac Growth, Contractile Performance, and Rhythmicity Physiol Rev, January 1, 2003; 83(1): 59 - 115. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. H. Lamers and A. F.M. Moorman Cardiac Septation: A Late Contribution of the Embryonic Primary Myocardium to Heart Morphogenesis Circ. Res., July 26, 2002; 91(2): 93 - 103. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. W. Kubalak, D. R. Hutson, K. K. Scott, and R. A. Shannon Elevated transforming growth factor {beta}2 enhances apoptosis and contributes to abnormal outflow tract and aortic sac development in retinoic X receptor {alpha} knockout embryos Development, January 2, 2002; 129(3): 733 - 746. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. T. Tsang, T.-Y. Hsia, R. W.M. Yates, and R. H. Anderson Surgical repair of supposedly multiple defects within the apical part of the muscular ventricular septum Ann. Thorac. Surg., January 1, 2002; 73(1): 58 - 62. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-S. Kim, S. Viragh, A. F. M. Moorman, R. H. Anderson, and W. H. Lamers Development of the Myocardium of the Atrioventricular Canal and the Vestibular Spine in the Human Heart Circ. Res., March 2, 2001; 88(4): 395 - 402. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. Anderson and B. R. Wilcox Reply Ann. Thorac. Surg., June 1, 2000; 69(6): 1990 - 1990. [Full Text] [PDF]
|
|
|
|
|
|
J. A. Dearani and G. K. Danielson Congenital Heart Surgery Nomenclature and Database Project: Ebstein's anomaly and tricuspid valve disease Ann. Thorac. Surg., April 1, 2000; 69(4): S106 - 117. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Webb, R. H. Anderson, W. H. Lamers, and N. A. Brown Mechanisms of Deficient Cardiac Septation in the Mouse With Trisomy 16 Circ. Res., April 30, 1999; 84(8): 897 - 905. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. W. Oosthoek, A. C. Wenink, L. J. Wisse, and A. C. Gittenberger-de Groot Development of the papillary muscles of the mitral valve: morphogenetic background of parachute-like asymmetric mitral valves and other mitral valve anomalies J. Thorac. Cardiovasc. Surg., July 1, 1998; 116(1): 36 - 40. [Abstract] [Full Text]
|
|
|
|
 |
|
 R. H Anderson, S. Webb, and N. A Brown The mouse with trisomy 16 as a model of human hearts with common atrioventricular junction Cardiovasc Res, July 1, 1998; 39(1): 155 - 164. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. C. Gittenberger-de Groot, M.-P. F.M. Vrancken Peeters, M. M.T. Mentink, R. G. Gourdie, and R. E. Poelmann Epicardium-Derived Cells Contribute a Novel Population to the Myocardial Wall and the Atrioventricular Cushions Circ. Res., June 1, 1998; 82(10): 1043 - 1052. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Ya, M. J. B. van den Hoff, P. A. J. de Boer, S. Tesink-Taekema, D. Franco, A. F. M. Moorman, and W. H. Lamers Normal Development of the Outflow Tract in the Rat Circ. Res., March 9, 1998; 82(4): 464 - 472. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Ya, E. B. H. W. Erdtsieck-Ernste, P. A. J. de Boer, M. J. A. van Kempen, H. Jongsma, D. Gros, A. F. M. Moorman, and W. H. Lamers Heart Defects in Connexin43-Deficient Mice Circ. Res., February 23, 1998; 82(3): 360 - 366. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Lakkis and J. Epstein Neurofibromin modulation of ras activity is required for normal endocardial-mesenchymal transformation in the developing heart Development, January 11, 1998; 125(22): 4359 - 4367. [Abstract] [PDF]
|
|
|
|
|
|
A. Wessels, M.W.M. Markman, J.L.M. Vermeulen, R.H. Anderson, A.F.M. Moorman, and W.H. Lamers The Development of the Atrioventricular Junction in the Human Heart Circ. Res., January 1, 1996; 78(1): 110 - 117. [Abstract] [Full Text]
|
|
|
|
 |
|
 W. M. Keyes and E. J. Sanders Regulation of apoptosis in the endocardial cushions of the developing chick heart Am J Physiol Cell Physiol, June 1, 2002; 282(6): C1348 - C1360. [Abstract] [Full Text] [PDF]
|
|