Heart valves

1. An Introduction to Cardiology
Nikhil Vaishnav, Clinical coordinator
Department of Paramedical & Health Science

2. Valves of the Heart
CHAPTER-3

3. Introduction
Image source : Google
The heart valves are uniquely designed gates that promote the unidirectional
flow of blood through the heart.
 There are two pairs of valves in the heart.
 The valves between each atrium and ventricle are referred to as
atrioventricular valves (right and left).
 The two valves that regulate the flow of blood from the ventricles to the
coronary, pulmonary, and systemic circulation are the semilunar valves
(pulmonary and aortic).

4. Heart valves

5. Heart valve

6. Atrioventricular valves
Image source : Google
The atrioventricular valves are pathways that allow blood to flow from
the atria to the ventricles.
 During ventricular contraction, blood does not flow back into the atria
owing to AV valves.
 During ventricular contraction, AV valve closed, produce first heart
sound.
 There are 2 AV valves: Right Atrioventricular Valve( Tricuspid valve) &
Left Atrioventricular Valve( Mitral valve)

7. AV valves

8. Tricuspid valve
Tricuspid valve
 Right AV valve or tricuspid valve is
located between the right atrium
and right ventricle.
Closed during ventricular
contraction.
 There is a Right fibrous ring that
forms the orifice of the valve.

9. Tricuspid valve
Image source : Google
 The Leaflets or cusps in tricuspid valve: A leaflet or cusps is a fleshy
projection that occludes the valve orifice thus prevents retrograde flow of
blood. There are 3 cusps in tricuspid valve. Anterior cusp 2. Septal cusp 3.
Posterior cusp.
 Anterior cusp: Also called as anterosuperior leaflet. It is attached to the
anterosuperior margin. It is the largest of the three cusps.
 Septal cusp : Also called as septal leaflet. It is attached to the septal
margin. It is the smallest of the three cusps.
 Posterior cusp: Also called as inferior leaflet. It is attached to the inferior
margin .

10. Tricuspid valve
Image source : Google
 The Chordae tendineae: Also called as tendinous cords or heart strings.
These are fibrous cords of connective tissue that connect the papillary
muscles to the tricuspid valve and the bicuspid
 Papillary muscle : Papillary muscle are muscles located in the ventricles of
the heart. They attach to the cusps of the atrioventricular valves via the
chordae tendineae. The papillary muscles constitute about 10% of the total
heart mass. There are 3 papillary muscles. 1. Anterior papillary muscle 2.
Septal papillary muscle 3. Posterior papillary muscle. Just Before ventricular
contraction, Papillary muscle of RV & LV start to contract so By bracing AV
valve against prolapse thus it Prevents regurgitation( Backward flow of blood).

11. Tricuspid valve clinical relevance
Image source : Google
Tricuspid stenosis.
Tricuspid regurgitation.
Tricuspid atresia.
 Ebstein's anomaly.

12. Tricuspid valve
Image source : Google

13. Bicuspid valve
Image source : Google
 Left AV valve or mitral valve or
bicuspid valve is located
between left atrium & left
ventricle.
Mitral valve is smaller than
tricuspid valve.
The left fibrous ring encircles
the bicuspid valve.
 The left fibrous ring encircles
the bicuspid valve.

14. Mitral valve

15. Bicuspid valve
Image source : Google
 Function: In normal conditions during atrial contraction (Diastolic phase),
greater pressure in the left atrium than ventricle thus blood flows through an
open mitral valve.
 Cusps of bicuspid valve : 2 cusps, anterior cusps and posterior cusps.
 Chordae tendinae: The true chordae tendineae arise from one of two
papillary muscles in the left ventricle
 Papillary muscles: Anterolateral papillary muscle, posteromedial papillary
muscle.

16. Bicuspid valve
Image source : Google
 Mitral annulus : The mitral annulus is a fibrous ring that is attached to the
mitral valve leaflets
 The annulus contracts and reduces its surface area during systole to help
provide complete closure of the leaflets.

17. Mitral valve

18. Mitral regurgitation
CLINICAL RELEVANCE
Mitral valve prolapse
 Mitral valve regurgitation
 Mitral stenosis

19. Semilunar valves
Image source : Google
 The semilunar valves are located between the ventricles and outflow
vessels.
 They carry blood away from the heart to pulmonary and systemic
circulations .
 Their cusps are semilunar in shape so called as semilunar valves.
 During ventricular relaxation closure of semilunar valves produce
second heart sound
 There are 2 semilunar valves: Pulmonary valve & aortic valve .

20. Semilunar valves

21. Pulmonary valve
Pulmonary valve
 It is located between the
right ventricle and the
pulmonary trunk (pulmonary
orifice).
The valve is oriented in an
oblique plane.
It is directed
posterosuperiorly toward the
left-hand side.

22. Pulmonary valve

23. Pulmonary valve
Image source : Google
 Cusps: 3 cusps Anterior, Right, Left.
 The free edge of each cusp presents a fibrous nodule at the centre
with two lateral thin portions, the lunule of semilunar cusp.
 Each cusp forms pocket like dilatation called pulmonary sinus at initial
portion of pulmonary trunk.
 The closure of the pulmonary valve contributes the P2 component of
the second heart sound (S2). It is usually softer than A2 component of
S2 heart sound .

24. Pulmonary valve

25. Image source : Google
 Function : In ventricular systole, Pressure in the right ventricle >the
pressure in the pulmonary artery, Pulmonary valve opens thus Blood is
ejected into pulmonary artery.
 Clinical relevance : Pulmonary valve stenosis, Pulmonary valve
regurgitation, Pulmonary atresia.

26. Aortic valve
Aortic valve
 The aortic valve is the larger
of the two semilunar valves.
 It located between the left
ventricle and the ascending
aorta (aortic orifice).
The aortic valve normally has
three cusps or leaflets, although
in 1–2% of the population it is
found to congenitally have two
leaflets..

27. Image source : Google
 Cusps : there are 3 cusps Right coronary (anterior)., Left coronary (left
posterior), Non-coronary cusp (right posterior, non-adjacent).
 The three cusps, when the valve is closed, contain a sinus called an aortic
sinus or sinus of Valsalva
Function : left ventricle contracts (systole), pressure rises in the left
ventricle, When the pressure in the left ventricle rises above the pressure
in the aorta, the aortic valve opens, Blood flows from the LV to aorta.
Clinical relevance : Aortic stenosis, aortic regurgitation.

28. Aortic valve

29. Embryology of heart valves
Embryology of heart valves
Valvulogenesis is the process by which
the heart valves develop.
It involves the formation and
maturation of the endocardial cushions
within the atrioventricular canal and
the outflow tract.
• They grow towards each other and
fuse, forming a physical barrier within
the heart lumen during the 5th
gestational week.
• As a result of this fusion, the heart
tube is divided into left and right
atrioventricular canals.

30. Embryology of heart valves

31. Surface marking of cardiac valves
Image source : Google

32. Surface marking of heart valve

33. Surface marking of heart valve

34. Surface marking of heart valve

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