The Tricuspid Valve: Alternative Name
The tricuspid valve is also known as the right atrioventricular valve, which accurately describes its anatomical position between the right atrium and right ventricle. 1
Anatomy of the Tricuspid Valve
- The tricuspid valve complex consists of the annulus, leaflets, right ventricle, papillary muscles, and chordae tendinae 1
- It is located between the right atrium (RA) and right ventricle (RV), positioned slightly more apically than the mitral valve 1
- The tricuspid valve has three leaflets of unequal size 1:
- Anterior leaflet - usually the largest, extending from the infundibular region anteriorly to the inferolateral wall posteriorly
- Septal leaflet - extends from the interventricular septum to the posterior ventricular border
- Posterior leaflet - attaches along the posterior margin of the annulus from the septum to the inferolateral wall
Imaging and Visualization
- The tricuspid valve can be visualized through several echocardiographic views 1:
- Parasternal long-axis view of RV inflow
- Parasternal short-axis view at the level of the aortic valve
- Apical 4-chamber view
- Subcostal view
- It is rarely possible to visualize all three leaflets simultaneously using 2D echocardiography 1
- Real-time 3D echocardiography allows simultaneous visualization of all three leaflets, their commissures, and attachment to the tricuspid annulus 1
- 3D echocardiography enables "en-face" views from both right ventricular and atrial perspectives 1
Clinical Significance
- The insertion of the septal leaflet of the tricuspid valve is characteristically more apical relative to the septal insertion of the anterior mitral leaflet 1
- Mild tricuspid regurgitation (TR) is frequent and benign, while moderate and severe TR are associated with poor prognosis 1, 2
- The most common cause of TR is not primary valve disease but rather impaired valve coaptation (secondary or functional TR) caused by dilation of the RV and/or tricuspid annulus 1
- Severe TR can lead to right ventricular dilation and eventual failure, causing increased RV diastolic pressure 1
Diagnostic Features in Tricuspid Valve Disease
- Systolic flow reversal in the hepatic veins is a specific marker for severe tricuspid regurgitation 2
- Right atrial and right ventricular dilatation are common findings in severe TR 2
- Dilated and pulsatile inferior vena cava and hepatic veins are characteristic of severe TR 2
- An end-systolic RV eccentricity index >2 (sensitivity 79%) is a diagnostic criterion for severe TR 2
Understanding the tricuspid valve's alternative name as the right atrioventricular valve helps reinforce its anatomical position and functional role in preventing blood backflow from the right ventricle to the right atrium during ventricular contractions.