A thorough understanding of valvar anatomy is essential for design engineers and clinicians in the development and/or employment of improved technologies or therapies for treating valvar pathologies. There are two arterial valves in the human heart--pulmonary and aortic valves. Both are complex structures whose normal anatomical components can vary greatly between individuals. We discuss the anatomy, pathology, and challenges relating to transcatheter and surgical repair/replacement of the arterial valves in a translational manner. The high prevalence of aortic valvar pathologies in the burgeoning elderly population, coupled with poor clinical outcomes for patients who go untreated, has resulted in prolific spending in the research and development of more effective and less traumatic therapies. The accelerated development of therapies for treating arterial valves has been guided by anatomical information gathered from high-resolution imaging technologies, which have focused attention on the need for complete understanding of arterial valvar clinical anatomies. This article is part of a JCTR special issue on Cardiac Anatomy.

A critical understanding of cardiac anatomy is essential for design engineers and clinicians with the intent of developing and/or employing improved or novel technologies or therapies for treating an impaired atrioventricular valve. Likewise, such knowledge is required for directing translational research, including initiating preclinical research, assessing the feasibility of clinical trials, and performing first-in-man procedures. There are two atrioventricular valves in the human heart, namely the tricuspid and mitral valves. Both are complex structures whose normal anatomies can vary greatly amongst individuals, and also become modified by disease processes. In this review, we discuss the anatomy, pathology, and issues related to surgical and transcatheter repair of the atrioventricular valves in a translational manner. This article is part of a JCTR special issue on Cardiac Anatomy.

Coronary venous valves could hinder or aid in the advancement of guide wires, catheters, and/or the placement of leads for a variety of cardiac interventional procedures. The characterization and quantification of venous valves could explain the difficulty or success in accessing targeted coronary venous locations.

Humans elicit complex and highly variable mitral valve anatomy. We suggest a complementary, yet simple nomenclature to address variation in mitral valve anatomy by describing clefts as either standard or deviant and locating regions in which they occur (A1 to A3 or P1 to P3).

T he complexity of intracardiac interventions has increased with the advent of transcatheter valve replacement, and advanced imaging modalities will be required both to plan and to guide these interventions. The imaging modalities currently used have limited temporal and spatial resolution. We set out to take a glimpse into the future by demonstrating the exquisite picture quality of direct visualization of a Melody* † (Medtronic) transcatheter pulmonary valve implantation 1-3 within the Visible Heart † (Medtronic). 4 With the advent of major advances in visualization techniques (eg, trans-blood, enhanced 4-D), this imaging quality could become a clinical reality.Endoscopic cameras were placed within the right ventricle of a human donor heart that was deemed not viable for transplantation. The heart was reanimated and perfused with a clear Krebs-Henseleit buffer according to previously described Visible Heart methodologies. 4 Furthermore, this heart had an intrinsic rhythm and could sustain function in a 4-chamber working mode. 4 Baseline systolic and diastolic right ventricular pressures were 35/4 mm Hg, and all steps of the transcatheter pulmonary valve implantation procedure could be monitored with direct visualization.Initially, a guidewire was positioned in the right ventricular outflow tract and across the native pulmonary valve (Data Supplement Movie I). Next, the delivery system was placed over the guidewire and advanced until the valve was properly positioned at the native pulmonary valve. Once in position, the transcatheter pulmonary valve was unsheathed. The overlay sheath protected the leaflets and chordae of the tricuspid valve from any damage that could have been caused by the collapsed stent of the transcatheter valve. The first balloon of the double-balloon delivery system was then inflated, partially deploying the valve. Finally, the second balloon of the delivery system was inflated, and the deployed transcatheter pulmonary valve could be observed (Data Supplement Movie I). Shown in Data Supplement Movie II is the implanted, functioning transcatheter pulmonary valve as viewed from the right ventricular outflow tract and from the pulmonary trunk, providing qualitative assessment of performance.The Visible Heart methodology provides imaging that should be considered the gold standard for clinical imaging modalities. At present, it offers new opportunities for in vitro and bench testing of new devices.