Pulmonary valve morphometry revisited: Clinical implications for valvular and supravalvular interventions

Abstract

In this cadaver-based study, we aimed to present a novel approach to pulmonary valve (PV) anatomy, morphometry, and geometry to offer comprehensive information on PV structure. The 182 autopsied human hearts were investigated morphometrically. The largest PV area was seen for the coaptation center plane, followed by basal ring and the tubular plane (626.7 ± 191.7 mm 2 vs. 433.9 ± 133.6 mm 2 vs. 290.0 ± 110.1 mm 2 , p < 0.001). In all leaflets, fenestrations are noted and occur in 12.5% of PVs. Only in 31.3% of PVs, the coaptation center is located in close vicinity of the PV geometric center. Similar-sized sinuses were found in 35.7% of hearts, in the remaining cases, significant heterogeneity was seen in size. The mean sinus depth was: left anterior 15.59 ± 2.91 mm, posterior: 16.04 ± 2.82 mm and right anterior sinus: 16.21 ± 2.81 mm and the mean sinus height: left anterior 15.24 ± 3.10 mm, posterior: 19.12 ± 3.79 mm and right anterior sinus: 18.59 ± 4.03 mm. For males, the mean pulmonary root perimeters and areas were significantly larger than those for females.Multiple forward stepwise regression model showed that anthropometric variables might predict the coaptation center plane (sex, age, and heart weight; R 2 = 33.8%), tubular plane (sex, age, and BSA; R 2 = 20.5%) and basal ring level area (heart weight and sex; R 2 = 17.1%). In conclusion, the largest pulmonary root area is observed at the coaptation center plane, followed by the basal ring and tubular plane. The PV geometric center usually does not overlap valve coaptation center. Significant heterogeneity is observed in the size of sinuses and leaflets within and between valves.Anthropometric variables may be used to predict pulmonary root dimensions.

Gross morphology and morphometry of native and decellularized heart valves of caprine: A comparative study

“…Similar findings were reported by Lis et al. (2023) in human pulmonary valves, where they found that there was no significant difference was seen in length between commissural end points. Islam et al.…”

“…In comparative analysis, while no significant differences were found in cusp thicknesses and commissural endpoint lengths among the RPC, LPC and APC, a significant difference in cusp lengths was identified between LPC and APC. Similar findings were reported by Lis et al (2023) in human pulmonary valves, where they found that there was no significant difference was seen in length between commissural end points. Islam et al (2005) conducted a study on the morphometric parameters of bovine aortic valves and reported a contrast to our findings.…”

Quadricuspid Pulmonary Valve With Fenestration: Cadaveric Findings

“…While the pulmonary valve normally has three semilunar leaflets (left, right, and anterior), in some cases, it can have an abnormal number of leaflets, such as two, four, or more (only one case of pentacuspid valve has been reported in the literature to date) [ 8 , 9 ]. Recently, Lis et al [ 5 ] revisited the anatomy of the tricuspid pulmonary valve and provided several morphometrical and geometrical descriptions. For instance, they reported that the mean intercommissural distance and geometric height (width and length in our study respectively) of the left anterior, right anterior, and posterior leaflets were 17.36 ±4.25 - 15.25 ±3.10 mm, 17.21 ±4.27 - 15.49 ±2.79 mm, and 17.62 ±3.61 - 15.69 ±3.38 mm respectively.…”

“…For instance, they reported that the mean intercommissural distance and geometric height (width and length in our study respectively) of the left anterior, right anterior, and posterior leaflets were 17.36 ±4.25 - 15.25 ±3.10 mm, 17.21 ±4.27 - 15.49 ±2.79 mm, and 17.62 ±3.61 - 15.69 ±3.38 mm respectively. Also, the authors identified the presence of fenestrations in all the leaflets of the pulmonary valve, with an occurrence rate of 12.5% [ 5 ].…”

“…Current estimates of the incidence of QPVs range from 0.1 to 0.2% of the general population [ 3 , 4 ]. While Hurwitz type-b QPVs are the most common variant, Hurwitz type-a cases are more often clinically diagnosed and more commonly associated with pulmonary regurgitation [ 5 ]. This contrasts with quadricuspid aortic valves (QAVs), which, while rarer, are insufficient valves about half of the time [ 6 ].…”