UW MEDICINE │ TITLE OR EVENT BIOSKILLS ONE THE TRICUSPID AND MITRAL VALVE COMPARATIVE ANATOMY MARK REISMAN, MD REISMANM@UW.EDU
Disclosure Statement of Financial Interest I, Mark Reisman, MD, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation. All TVT 2017 faculty disclosures are listed online and on the app.
AIMS • Anatomical Differences between the tricuspid and mitral valve • Relational anatomy • Pathology of mitral valve
THE TRICUSPID AND MITRAL VALVE
RELATIONSHIP OF TV TO MV Non coronary Cusp of Aortic Valve Septal leaflet Of tricuspid valve Coronary sinus 5
LEFT ATRIUM VS RIGHT ATRIUM 6
THE RIGHT ATRIUM Tricuspid ring MS A AV Node S P CS Triangle of Koch 7
THE LEFT ATRIUM 8
Ventricular relationship PV TV Pulmonary valve The mitral valve with the Aortic valve backlit 11
RELATIONAL ANATOMY OF THE MITRAL VALVE LVOT RVOT LVOT 12
MITRAL AND TRICUSPID LEAFLETS A S P CS 14
THE MTRAL LEAFLETS posterior anterior 15
SEPARATION OF ANTERIOR AND SEPTAL LEAFLET OF THE TRICUSPID LEAFLET Optimal location for mitraclip 16
CHORDAL STRUCTURE OF THE TV AND MV Commissures Defined by the presence of Fan chords 17
CHORDAE AND PAPILLARY MUSCLES LMCA MV CT more typical CT directly attached to the septum PM 19
PAPILLARY MUSCLES OF THE TRICUSPID AND MITRAL VALVES MV TV MV MV 20
CHORDAL/LEAFLET ATTACHMENTS OF THE MITRAL VALVE Similar insertions on the tricuspid valve 21
PATHOLOGY 23
MITRAL ANNULAR CALCIFICATION Impact on several TMVR devices 24
CHORDAL RUPTURE AND LEAFLET THICKENING OF THE MITRAL LEAFLET 25
CONCLUSION • Both valves are excellent targets for percutaneous therapy • Both valves has unique set of challenges due to anatomy and relational anatomy • I anticipate there will be percutaneous solutions to the majority of pathologies affecting both the tricuspid and mitral valve 31
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