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Ann Thorac Surg 2000;69:1990
© 2000 The Society of Thoracic Surgeons

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Correspondence

Reply

^a Cardiac Unit, Institute of Child Health, University College London, 30 Guilford St, London, England WC1N 1EH, United Kingdom
^b Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7065, USA

e-mail: benson{at}med.unc.edu

To the Editor

We thank Drs Victor and Nayak for their response, albeit much delayed, to our comments concerning the tricuspid valve. There is, however, no misunderstanding, at least, not on our part. We have debated this matter previously, and have published our own analysis of the arrangement of the tricuspid valve [1] subsequent to their study [2]. Victor and Nayak steadfastly refuse to contemplate the alternative interpretation. As we stressed in the review that they question [3], valves function when their leaflets are closed. Valves with two leaflets then have a solitary zone of apposition, whereas those with three leaflets close in trifoliate fashion. As we demonstrated in our own analysis [1], and as is well known to echocardiographers, the tricuspid valve indeed closes in trifoliate fashion, and therefore possesses the three leaflets recognized by Erasistratos. We also pointed out in our review [3] that the evidence from hearts with Ebstein’s malformation militates against the concept advanced by Victor and Nayak. In fact, the mural leaflet is that which is derived initially by a process of undermining of the muscular diaphragmatic surface of the inlet of the right ventricle [4]. The antero-superior leaflet, in contrast, has a markedly different developmental origin. Victor and Nayak are fond themselves of citing evidence from development sources to support their anatomic hypotheses. All this evidence, morphologic, functional, and developmental, supports the notion that the tricuspid valve has three leaflets, providing that the valve is analyzed in its closed position as well as viewed exclusively when open as in the autopsied specimen.

References

1. Sutton J.P., III, Ho S.Y., Vogel M., Anderson R.H. Is the morphologically right atrioventricular valve tricuspid?. J Heart Valve Dis 1995;4:571-575.[Medline]
2. Victor S., Nayak V.M. The tricuspid valve is bicuspid. J Heart Valve Dis 1994;3:27-36.[Medline]
3. Anderson R.H., Wilcox B.R. Understanding cardiac anatomy. Ann Thorac Surg 1995;59:1366-1375.[Abstract/Free Full Text]
4. Lamers W.H., Virágh S., Wessels A., Moorman A.F.M., Anderson R.H. Formation of the tricuspid valve in the human heart. Circulation 1995;91:111-121.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Robert H. Anderson Benson R. Wilcox Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Anderson, R. H. Articles by Wilcox, B. R. Search for Related Content PubMed Articles by Anderson, R. H. Articles by Wilcox, B. R. Related Collections Related Article