Three-Dimensional Geometry Values and Clinical Determinants for the Annulus of the Tricuspid Valve in a Japanese Population.

The tricuspid annulus (TA) is the primary target of tricuspid valve (TV) surgery for tricuspid regurgitation (TR). However, the reference values for TA geometry in the Japanese population is currently unavailable. We aimed to elucidate the geometric reference values of the TA in Japanese individuals using 3-dimensional (3D) echocardiography.We conducted a prospective study using transthoracic 3D echocardiography on 142 healthy Japanese subjects aged between 20 and 79 years. The tricuspid geometric parameters in the late-diastole and the mid-systole were analyzed using custom 3D software (Realview™).After excluding 46 subjects with poor images, data from 96 subjects (67.6%) were analyzed. TA area and circumference showed strong correlations with body surface area (BSA) (P < 0.001 for all), while some of these parameters exhibited weak correlations with age. Gender differences in TV geometry were assessed across 3 age groups: 20-39 years (42 subjects), 40-59 years (28 subjects), and 60-79 years (26 subjects). In the youngest subjects (20-39 years), males had a significantly larger TA area and smaller anterior-posterior and medial-lateral diameters (P < 0.001 for all), even after adjusting for BSA, indicating gender differences of TA geometry. These differences diminished with age.We present reference values for TA geometry by age and gender in a Japanese cohort. BSA may be a suitable metric for indexing the TA parameters. While age-related changes in TA parameters may not be significant, gender differences, particularly in younger individuals, persist even after adjusting for BSA.

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

The gross morphological examination of native caprine heart valves revealed distinctive structural characteristics of the caprine's cardiac anatomy. Four primary orifices were identified, each protected by thin, valve-like structures. Atrioventricular orifices featured tricuspid and bicuspid valves, while the aorta and pulmonary arteries were guarded by semilunar valves. Within the atrioventricular apparatus, distinct features were observed including the tricuspid valve's three leaflets and the bicuspid valve's anterior and posterior leaflets. Ultrasonography provided insights into valve thickness and chordae tendineae lengths. Morphometric studies compared leaflets/cusps within individual native valves, showcasing significant variations in dimensions. Comparative analysis between native and decellularized valves highlighted the effects of decellularization on leaflet thickness and chordae tendineae lengths. Decellularized valves exhibited reduced dimensions compared to native valves, indicating successful removal of cellular components. While some dimensions remained unchanged post-decellularization, significant reductions were observed in leaflet thicknesses and chordae tendineae lengths. Notably, semilunar valve cusps displayed varying responses to decellularization, with significant reductions in cusp lengths observed in the aortic valve, while the pulmonary valve exhibited more subtle changes. These findings underscore the importance of understanding structural alterations in heart valves post-decellularization, providing valuable insights for tissue engineering applications and regenerative medicine.

Anatomical evaluation of a novel echocardiography based tricuspid valve classification in 60 hearts from body donors.

OBJECTIVES: This study aimed to provide comprehensive morphological descriptions of the morphology of the tricuspid valve and to evaluate if a novel echocardiography-based tricuspid valve nomenclature can also be understood anatomically. METHODS: Tricuspid valves of 60 non-embalmed human body donors without a medical history of pathologies or macroscopic malformations of the heart were included. Length, height and surface area of leaflets were measured. The valves were morphologically classified according to a novel echocardiography-based classification, in which 6 types are distinguished: classic 3-leaflet configuration, bicuspid valves, valves with 1 leaflet split into 2 scallops or leaflets and valves with 2 leaflets divided into 2 scallops or leaflets. RESULTS: We found a true 3-leaflet configuration in only 19 (31.7%) of valves. Five (8.3%) had a 2-leaflet configuration with a fused anterior and posterior leaflet. Of those, 3 had a divided septal leaflet. Four valves (6.7%) had a divided anterior leaflet, 17 (28.3%) had a divided posterior leaflet, 6 (10%) had a divided septal leaflet and 9 (15.0%) had 2 leaflets divided. Overall, 39 (65%) of valves have at least 1 leaflet that is divided. In 22 (36.7%) specimens, the leaflet was divided into true leaflets, and in 17 (28.3%) specimens, the leaflet was divided into scallops. In addition, we could identify 9 (15%) valves having 1 leaflet divided not only in 2 but 3 scallops or leaflets. CONCLUSIONS: This study provides further anatomical insight for the significant variability in the morphology of the tricuspid valve. By updating the understanding of its morphological characteristics, this study equips clinicians with valuable insights to effectively advance surgical and interventional treatment of tricuspid valves.

Como eu faço a avaliação pós-intervenções tricúspides: dicas e truques / My approach to assessment after tricuspid interventions: tips and tricks

A regurgitação tricúspide (RT) importante está associada à alta morbidade e mortalidade. Como o tratamento cirúrgico da RT isolada tem sido associado à alta mortalidade, as intervenções transcateter na valva tricúspide (VT) têm sido utilizadas para o seu tratamento, com risco relativamente mais baixo. Há um atraso na intervenção da RT e provavelmente está relacionado a uma compreensão limitada da anatomia da VT e do ventrículo direito, além da subestimação da gravidade da RT. Nesse cenário, faz-se necessário o conhecimento anatômico abrangente da VT, a fisiopatologia envolvida no mecanismo de regurgitação, assim como a sua graduação mais precisa. A VT tem peculiaridades anatômica, histológica e espacial que fazem a sua avalição ser mais complexa, quando comparado à valva mitral, sendo necessário o conhecimento e treinamento nas diversas técnicas ecocardiográficas que serão utilizadas frequentemente em combinação para uma avaliação precisa. Esta revisão descreverá a anatomia da VT, o papel do ecocardiograma no diagnóstico, graduação e fisiopatologia envolvida na RT, as principais opções atuais de tratamento transcateter da RT e a avaliação do resultado após intervenção transcateter por meio de múltiplas modalidades ecocardiográficas.(AU)

Severe tricuspid regurgitation (TR) is associated with high morbidity and mortality. Given that surgical treatment of TR alone has been associated with high mortality, transcatheter interventions in the tricuspid valve (TV) have been used for its treatment, with relatively lower risk. There is a delay in intervention for TR, and this is probably related to a limited understanding of the anatomy of the TV and the right ventricle, in addition to an underestimation of the severity of TR. In this scenario, it is necessary to have comprehensive anatomical knowledge of the TV, the pathophysiology involved in the mechanism of regurgitation, and more accurate grading. The TV has anatomical, histological, and spatial peculiarities that make its assessment more complex when compared to the mitral valve, requiring knowledge and training in the various echocardiographic techniques that will often be used in combination for accurate assessment. This review will describe the anatomy of the TV, the role of echocardiography in the diagnosis, grading, and pathophysiology involved in TR; the main transcatheter treatment options currently available for TR; and the assessment of outcomes after transcatheter intervention by means of multiple echocardiographic modalities.(AU)

Excursão sistólica do anel tricúspide e do anel mitral: correlação com função diastólica ventricular esquerda / Tricuspid annular plane systolic excursion and mitral annular systolic excursion: correlation with left ventricular diastolic function

Introdução: A excursão sistólica do anel tricúspide e a do anel mitral são parâmetros utilizados para se avaliar a função contrátil do ventrículo direito e do ventrículo esquerdo, respectivamente. Pouco se conhece sobre sua relação com a função diastólica ventricular esquerda. Objetivo: Avaliar se os valores de excursão sistólica do anel tricúspide e do anel mitral se correlacionam com parâmetros utilizados na avaliação da função diastólica ventricular esquerda. Métodos: Estudo observacional transversal. Foram selecionados 219 indivíduos, sendo 116 mulheres, com função sistólica preservada de ambos os ventrículos. As análises foram feitas separadamente para os sexos masculino e feminino, por meio dos coeficientes de correlação de Pearson e de Sperman. Foram obtidos: excursão sistólica do anel tricúspide, excursão sistólica do anel mitral, volumes atriais e medidas relacionadas à avaliação da função diastólica do ventrículo esquerdo ao ecocardiograma transtorácico. Resultados: No sexo feminino, a excursão sistólica do anel mitral se correlacionou positivamente com o e' lateral (coeficiente de correlação de Sperman de 0,22; p=0,016) e a excursão sistólica do anel tricúspide se correlacionou positivamente com a relação E/A (coeficiente de correlação de Sperman de 0,23, p=0,037), com o e' lateral (coeficiente de correlação de Sperman de 0,28; p=0,012), com o e' septal (coeficiente de correlação de Sperman de 0,28; p=0,012) e negativamente com a relação E/e' (coeficiente de correlação de Pearson de -0,27; p=0,018) e onda A (coeficiente de correlação de Pearson de -0,29; p= 0,009). No sexo masculino, apenas a excursão sistólica do anel mitral se correlacionou positivamente com a onda E (coeficiente de correlação de Pearson de 0,21; p=0,037), e' lateral (coeficiente de correlação de Sperman de 0,34; p <0,001) e e' septal (coeficiente de correlação de Sperman de 0,26; p=0,008). Não houve correlação entre excursão sistólica do anel mitral e do anel tricúspide e volumes atriais. A presença de hipertensão arterial sistêmica e diabetes melito influenciou nos valores de excursão sistólica do anel tricúspide e do anel mitral correlacionados a ondas E e A, relação E/A, ondas e' septal e lateral e relação E/e'. Conclusão: No presente estudo, os valores da excursão sistólica do anel mitral e do anel tricúspide apresentaram correlação significativa com algumas variáveis da função diastólica ventricular esquerda com maior evidência no sexo feminino.(AU)

Introduction: Tricuspid annular plane systolic excursion and mitral annular systolic excursion are parameters used to assess the systolic function of the right ventricle and left ventricle, respectively. Little is known about its relationship with left ventricular diastolic function. Objective: To assess whether the values of mitral annular systolic excursion and tricuspid annular plane systolic excursion correlate with parameters used in the evaluation of left ventricular diastolic function. Method: Observational cross-sectional study. Two hundred nine individuals were selected, 116 women, with both ventricles normal systolic function. The analyzes were performed for men and women, through Pearson correlation coefficient and Sperman correlation coefficient. Tricuspid annular plane systolic excursion, mitral annular systolic excursion, atrial volumes and left ventricular diastolic function parameters on transthoracic echocardiogram were obtained. Results: In women, mitral annular systolic excursion was positively correlated with lateral e '(Sperman correlation coefficient of 0.22; p=0.016) and tricuspid annular plane systolic excursion was positively correlated with E / A ratio (Sperman correlation coefficient of 0.23; p=0.037), lateral e' (Sperman correlation coefficient of 0.28; p=0.012), and septal e' (Sperman correlation coefficient of 0.28; p=0.012), and negatively with the E/e' ratio (Pearson correlation coefficient of -0.27; p=0.018), and A wave (Pearson correlation coefficient of -0.29; p=0.009). In men, only mitral annular systolic excursion correlated positively with E wave (Pearson correlation coefficient of 0.21; p=0.037), lateral e' (Sperman correlation coefficient of 0.34; p <0.001) and the septal e' (Sperman correlation coefficient of 0.26; p=0.008). There was no correlation between mitral annular systolic excursion E and tricuspid annular plane systolic excursion and atrial volumes. Hypertension and diabetes mellitus influenced tricuspid annular plane systolic excursion and mitral annular systolic excursion values correlated to E and A waves, E/A ratio, septal and lateral e' waves, and E/e' ratio. Conclusion: In the present study, mitral annular systolic excursion and tricuspid annular plane systolic excursion values showed a significant correlation with some parameters of left ventricular diastolic function, with stronger evidence on female sex.(AU)

[Functional tricuspid regurgitation: imaging, surgical indications, reparative techniques and results]. / L'insufficienza tricuspidale funzionale: imaging, indicazioni chirurgiche, tecniche riparative e risultati.

Although the indications for surgical management of severe functional tricuspid regurgitation (TR) are now generally accepted, controversy persists concerning the role of intervention for moderate TR. However, there is a trend for intervention in this setting, particularly in patients with annular dilation. Echocardiographic imaging is the gold standard to identify functional TR and distinguish it from a primitive or degenerative form. Currently, surgery remains the best approach for the interventional treatment of TR. Ring annuloplasty seems to provide better results than suture annuloplasty (De Vega technique) and rigid rings appear to be more reliable in the long term, in comparison with flexible bands. Tricuspid valve repair is more beneficial compared with replacement, except in highly selected cases of long-standing TR with multifactorial mechanism.

Functional Grading of a Transversely Isotropic Hyperelastic Model with Applications in Modeling Tricuspid and Mitral Valve Transition Regions.

Surgical simulators and injury-prediction human models require a combination of representative tissue geometry and accurate tissue material properties to predict realistic tool-tissue interaction forces and injury mechanisms, respectively. While biological tissues have been individually characterized, the transition regions between tissues have received limited research attention, potentially resulting in inaccuracies within simulations. In this work, an approach to characterize the transition regions in transversely isotropic (TI) soft tissues using functionally graded material (FGM) modeling is presented. The effect of nonlinearities and multi-regime nature of the TI model on the functional grading process is discussed. The proposed approach has been implemented to characterize the transition regions in the leaflet (LL), chordae tendinae (CT) and the papillary muscle (PM) of porcine tricuspid valve (TV) and mitral valve (MV). The FGM model is informed using high resolution morphological measurements of the collagen fiber orientation and tissue composition in the transition regions, and deformation characteristics predicted by the FGM model are numerically validated to experimental data using X-ray diffraction imaging. The results indicate feasibility of using the FGM approach in modeling soft-tissue transitions and has implications in improving physical representation of tissue deformation throughout the body using a scalable version of the proposed approach.

Early bioprosthetic tricuspid valve stenosis due to size mismatch in Ebstein anomaly-Successful transcatheter treatment.

Patients with congenital heart disease are surviving well into adulthood thanks to advances in medical and clinical care. We present a patient with Ebstein anomaly who underwent surgical tricuspid valve replacement and suffered early valve stenosis due to her unique anatomy. This case highlights the importance of the "unnatural" anatomy that can be encounter in this challenging patient population.

Longitudinal Reference Ranges for Tricuspid Annular Plane Systolic Excursion and Mitral Annular Plane Systolic Excursion in Normally Grown Fetuses.

OBJECTIVES: The aim of this study was to construct reference ranges for fetal tricuspid annular plane systolic excursion (TAPSE) and mitral annular plane systolic excursion (MAPSE) using conventional M-mode ultrasound (US) in the second half of pregnancy. METHODS: Participants underwent US scans every 4 weeks from 18 weeks' gestation until delivery. The TAPSE and MAPSE were measured by conventional M-mode US at each examination. The relationships between TAPSE and MAPSE and gestational age and estimated fetal weight were modeled by Bayesian mixed effects linear regression. RESULTS: Positive linear relationships were observed between both MAPSE and TAPSE and gestational age and estimated fetal weight. Reference centiles for TAPSE and MAPSE were developed. CONCLUSIONS: This simple technique is a useful tool for assessing cardiac function and could be used for quantitative assessments of fetal cardiac function, particularly in high-risk pregnancies such as those complicated by maternal diabetes.

Análise Ecocardiográfica das Câmaras Direitas segundo Sexo e Superfície Corporal / Echocardiographic Assessment of Right Chambers by Gender and Body Surface Area

Introdução: A avaliação sistemática das dimensões e da função das câmaras direitas, de acordo com sexo, idade, superfície corporal e índice de massa corporal, não é uniformemente realizada. Objetivo: Avaliar, ao ecocardiograma transtorácico, as dimensões e a função das câmaras direitas de acordo com o sexo, superfície corporal e índice de massa corporal em uma população ambulatorial. Métodos: Estudo observacional, transversal. Foram selecionados 81 pacientes, 60,4 ± 13,5 anos, de ambos os sexos (57 mulheres, 70%). Foram avaliados: diâmetro proximal do ventrículo direito, basal do ventrículo direito, médio e longitudinal; área do átrio direito e volume do átrio direito; espessura da parede livre do ventrículo direito; excursão sistólica do anel valvar tricúspide; e Doppler tecidual do anel tricúspide, onda S'. Resultados: O sexo feminino apresentou menores diâmetros em relação ao sexo masculino (teste t de Student) de diâmetro proximal do ventrículo direito (20,6 mm ± 2,4 vs. 22,7 mm ± 2,2; p = 0,001), basal do ventrículo direito (34,4 mm ± 3,5 vs. 38,2 mm ± 4,8; p < 0,001), diâmetro médio do ventrículo direito (27 mm ± 3,3 vs. 32,4 mm ± 4,9; p < 0,001), área do átrio direito (13,7 cm² ± 2,7 vs. 16,6 cm² ± 3,9; p = 0,002) e volume do átrio direito (37 mL ± 10,6 vs. 50,7 mL ± 15,6 ; p = 0,002). O índice de massa corporal e a superfície corporal se correlacionaram positivamente com o diâmetro proximal do ventrículo direito (coeficiente de correlação - CC 0,24; p = 0,03), diâmetro basal do ventrículo direito (CC 0,22; p = 0,04), diâmetro médio do ventrículo direito (CC 0,23; p = 0,04), diâmetro longitudinal do ventrículo direito (CC 0,28; p = 0,01), área do átrio direito (CC 0,40; p = 0,001) e volume do átrio direito (CC 0,24; p = 0,0006). Conclusão: As médias dos diâmetros ventriculares, área e volume atriais direitos foram menores no sexo feminino. Foi encontrada correlação positiva destes parâmetros com o índice de massa corporal e a superfície corporal. Os valores da excursão sistólica do anel valvar tricúspide e S' não foram influenciados por sexo, índice de massa corporal e superfície corporal.

Introduction: Assessment of right chambers dimensions and function according to gender, age, body surface area and body mass index is not uniformly performed. Objective: To evaluate, by transthoracic echocardiography dimensions and function of right chambers, according to gender, body surface area and body mass index in an outpatient population. Method: Cross-sectional study. Eighty-one patients were selected, 60.4 ± 13.5 years (57 women, 70%). Parameters assessed were the following: proximal, basal, medium and longitudinal, right ventricle diameter; right atrium area and right atrium volume; right ventricle wall thickness; tricuspid annular plane systolic excursion; and tricuspid annulus tissue Doppler and S' wave. Results: Female sex presented lower diameters (Student's t-test) of proximal right ventricle diameter (20.6 mm ± 2.4 vs. 22.7 mm ± 2.2; p = 0.001), basal right ventricle diameter (34,4 mm ± 3,5 vs. 38,2 mm ± 4,8; p <0.001), medium right ventricle diameter (27 mm ± 3.3 vs. 32.4 mm ± 4.9; p <0.001), right atrium area (13.7 cm² ± 2.7 vs. 16.6 cm² ± 3.9; p = 0.002) and right atrium volume (37 mL ± 10.6 vs.

Essential roles for CT and MRI in timing of therapy in tricuspid regurgitation.

The rapid development of transcatheter tricuspid valve intervention (TTVI) therapies has quickly provided the opportunity to improve patient selection and procedural planning for patients with significant tricuspid regurgitation (TR) considered at high surgical risk. This review focuses on the contributions which both computed tomography angiography and cardiac magnetic resonance can provide in the better understanding of the natural history of TR, in the comprehensive anatomical and functional assessment of right heart involvement and in the timing and planning for TTVI. We also discuss areas of potential importance such as the quantification of response to TTVI, which will be informative for future trials.

Assessment and procedural guidance with echocardiography for transcatheter tricuspid regurgitation devices.

Echocardiographic imaging is an integral part of characterizing patients with tricuspid regurgitation (TR) and helps in determining the timing of intervention and procedural guidance for transcatheter interventions. The rapid advances in both two-dimensional and three-dimensional imaging however have facilitated the development and deployment of novel transcatheter devices to address the unmet need for patients with symptomatic severe TR.

Transcatheter repair of tricuspid regurgitation with MitraClip.

Transcatheter therapy with the MitraClip system (Abbott Structural, Menlo Park, CA) is the most commonly used transcatheter therapy for patients with tricuspid regurgitation, with over 1000 cases performed worldwide. The procedure is an off-label approach that requires meticulous attention to anatomical features obtained via comprehensive echocardiography and, in some cases, using cardiac computed tomography. Herein, we describe patient selection, procedural performance, and clinical outcomes of this therapy.

Specific Anatomic Considerations for Tricuspid Interventions.

PURPOSE OF REVIEW: This review discusses the normal anatomy and pathology of the tricuspid valve (TV) and right side of the heart. Emphasis is on those anatomic and pathologic features relevant to interventions intended to restore normal function to the TV in disease states. RECENT FINDINGS: TV pathology is less common than aortic and mitral valve pathology, and treatment and outcomes for interventions face considerable hurdles. New innovations and early data showing safety and efficacy in transcatheter interventions have transformed TV interventions into the next frontier in cardiac valve disease treatment. Certain features of the TV and right heart have presented themselves as potential targets, as well as impediments, for TV intervention. The causes of TV pathology and the anatomy of the TV and right heart bring unique challenges to intervention. Approaches to intervention will continue to progress and change the way we view and treat TV pathology.

Anatomy of the cavotricuspid isthmus for radiofrequency ablation in typical atrial flutter.

BACKGROUND: Radiofrequency (RF) catheter ablation is one of the most common strategies for the current management of cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL). The interindividual anatomic variability can influence the duration and outcome of ablation procedure. OBJECTIVE: The purpose of this study was to establish complication rates in patients undergoing RF catheter ablation for CTI-dependent AFL, assess the role of CTI morphology in procedural success, and determine the anatomic variability of CTI ex vivo. METHODS: RF catheter ablation for CTI-dependent AFL was performed in 337 consecutive patients. Angiographically determined CTI morphology was classified as either simple or complex due to pouchlike recesses. Macroscopic and histologic examination of the CTI was performed in 104 heart specimens from consecutive autopsies. RESULTS: Complex CTI anatomy was present in 10.9% of AFL patients. RF application time to achieve bidirectional isthmus block was longer in patients showing pouchlike recesses than in those without (10.7 vs 8.3 min; P= .025). Acute procedure failure or major complications occurred in 3 cases, all with complex CTI anatomy. A pouchlike recess of the CTI was present in 9.6% of autopsy hearts. Histomorphometric analysis of the CTI atrial wall demonstrated that the central level was the thinnest in the 3 sectors and the paraseptal level was the thickest. CONCLUSION: Although RF catheter ablation is a safe and effective procedure for AFL treatment, CTI anatomic complexity can affect ablation parameters and outcome. Standard definition of CTI morphologic variants is recommended. Preprocedural assessment of CTI anatomy might lead to personalized ablation preventing potential difficulties and complications.

Normal Reference Values and Reproducibility of Tricuspid Annulus Dimensions Using Cardiovascular Magnetic Resonance.

Tricuspid annular (TA) dilation is a key process in functional tricuspid regurgitation, but normal TA dimensions using cardiovascular magnetic resonance have not been established. We measured TA diameters in 66 healthy volunteers, aged 38 ± 11 years, during 3 different phases of the cardiac cycle (end-systole, early diastole, and end-diastole) and in 2 routinely acquired cardiovascular magnetic resonance imaging planes (4-chamber [4C] and right ventricular inflow-outflow [RVIO]). Three readers independently measured each value and 1 reader repeated measurements 1 month apart. The upper limit of normal (ULN) was calculated as 1.96 standard deviations above the mean. We assessed inter- and intraobserver reliability using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. We found the TA diameter largest during early diastole in the 4C view with an ULN of 43 mm (22 mm/m2). Men had larger absolute TA diameters (36 mm, 95% CI 27 to 44 mm) than women (30 mm, 95% CI 23 to 37 mm) but not after indexing for body surface area (both 18 mm/m2). In the RVIO view, the largest TA diameter occurred during early diastole with a ULN value of 46 mm (27 mm/m2). In this view, females had a larger indexed TA than men (21 mm/m2 vs 17 mm/m2). Reproducibility of measurements was excellent in all cardiac phases with an inter-rater ICC between 0.90 to 0.96 and an intrarater ICC 0.89 to 0.96. In conclusion, we have provided normative data regarding TA dimensions in routinely acquired 4C and RVIO views, and these values are larger than the current thresholds of annular dilation measured by echocardiography. Gender differences with the TA diameter in the RVIO view may be an important finding with consideration of future tricuspid devices.

Morpho-functional characterization of the heart of Gallus gallus domesticus with special reference to the right muscular atrioventricular valve.

In this work, we studied the structure and function of the adult chicken heart with a focus on the right muscular atrioventricular valve using anatomic and echocardiographic methods. We demonstrated that the free wall thickness of the right and left ventricles changes from the apex to the base of the heart. The right muscular atrioventricular valve (RAVV) is joined directly to both the parietal right ventricle free wall (one attachment) and the interventricular septum (two attachments: ventral and dorsal). This valve does not have chordae tendineae or papillary muscles. The quantitative morphological and functional characterization of the RAVV is given. In color Doppler echo, no regurgitation of blood flow in the RAVV was observed in any of the studied birds. The blood flow velocity in the RAVV is 56.2 ± 9.6 cm s-1 . A contractile function of the RAVV is shown. Based on the findings obtained, we conclude that the RAVV has a sufficient barrier function. In addition, as this valve is an integral part of the right ventricle free wall, it contributes to the right ventricle pump function. An agreed nomenclature of the parts of the RAVV is required.