Aim: The aim of this study is to report the rare anomaly of accessory cusp present in the tricuspid valve.
Background: The right atrioventricular valve also known as the tricuspid valve allows the blood to flow from the right atrium to the right ventricle. Tricuspid diseases although rare but tricuspid valve regurgitation, stenosis, and Ebstein's anomaly are included.
Case description: During routine dissection of normal adult formalized heart for undergraduate medical students at the Department of Anatomy, SGRD Medical College, Amritsar, we noticed four cusps of the right atrioventricular valve. They were anterior, septal, posterior, and accessory valves which were anterolateral in position. The septal cusp was the largest of all. The papillary muscles were anterior, posterior, and septal and one for the accessory cusp.
Conclusion: This anomaly is important for the cardiothoracic surgeon for correcting their defects.
Silver MD, Lam JHC, Ranganathan N, et al. Morphology of the human tricuspid valve. Circulation 1971;43:333-348.
Walls EW. The blood vascular and lymphatic systems. In: Romanes GJ, ed. Cunningham's Textbook of Anatomy. New York: Oxford University Press, 1995; pp.871-1008.
Xanthos T, Dalivigkas I, Ekmektzoglou KA. Anatomic variations of the cardiac valves and papillary muscles of the right heart. Ital J Anat Embryol 2011;116:111-126.
Faggian G, Frescura C, Thiene G, et al. Accessory tricuspid valve tissue causing obstruction of the ventricular septal defect in tetralogy of Fallot. Br Heart J 1983;49:324-327. doi: 10.1136/hrt.49.4.324.
Tandler J. Anatomie des Herzens. In: Van Bardeleben K, ed. Handbuch der Anatomie des Menchen. Jena: G. Fischer, 1913; pp.84-90.
Testut L, Latarjet A. Traite d' anatomie humaine. Paris: G. Doin Cie, 1948; vol. II.
Jastrzebski C. O zmiennosci ksztattu zastawki trojdzielnej serca I o otworach wrodzonych w jej platkach. Kosmos Seria A Biologia 1926;51:191.
Shah PM. The heart. Tricuspid valve, pulmonary valve and multivalvular disease. 13th ed. McGraw Hill Medical, 2011; p.1748.
Lang D, Oberhoffer R, Cook A, et al. Pathologic spectrum of malformations of the tricuspid valve in prenatal and neonatal life. J Am Coll Cardiol 1991;17:1161-1167.
Aoyagi S, Maruyama H, Akasu K, et al. Isolated tricuspid valve regurgitation resulting from severe annular dilatation: case report. J Heart Valve Dis 1999;8(4):457-459.
Moore KL. Clinically oriented anatomy. 4th ed. Baltimore: Lippincott William & Wilkins, 1992; pp.111-127, ch. 1.
Chauhan KR, Udainia A, Mehta CD, et al. Study of incidence of an abnormal tricuspid valve in the human cadaveric heart. Natl J Med Res 2014;4(3):238-240.
Skwarek M, Hreczecha J, Dudziak M, et al. The morphology and distribution of the tendinous chords and their relation to the papillary muscles in the tricuspid valve of the human hearts. Folia Morphol 2007;66:314-322.
Kocak A, Govsa F, Aktas EO, et al. Structure of the human tricuspid valve leaflets and its chordae tendineae in unexpected death. A forensic autopsy study of 400 cases. Saudi Med J 2004;25(8):1051-1059.
Sutton JP, Ho SY, Vogel M, et al. Is the morphologically right atrioventricular valve tricuspid. J Heart Valve Dis 1995;4(6): 571-575.
Gerola LR, Wafae N, Vieira MC, et al. Anatomic study of the tricuspid valve in children. Surg Radial Anat 2001;22(3): 149-153.
Ankolekar VH, Das A, Dsouza A, et al. Tetracuspid right atrioventricular valve: a case report. Int J Health Sci Res 2014;4(11):253-255.
Motabagani MAB. Comparative anatomical, morphometric and histological studies of the tricuspid valve-complex in human and some mammalian hearts. J Anat Soc Ind 2006;55(1):1-23.
Yoon A, Shaqra H, Levin M, et al. Accessory tricuspid valve leaflet in an asymptomatic adult. Tex Heart Inst J 2008;35: 327-328.