三尖瓣的应用解剖学研究

CLINICAL ANATOMICAL STUDY ON HUMAN TRICUSPID VALVE

用肉眼、光镜和图像分析法对35例离体心脏问(30例固定标本,5例新鲜标本)的三尖瓣及其连合进行广形态学观察和测量,并对各尖瓣基带内的心肌纤维的来源、性质及分布进行了研究.结果表明:前、后、膈尖瓣的面积分别为445.76±6354 mm^2,480.54±120.56mm^2,361.44±95.07mm^2.三尖瓣连合部可分为连合型和无连合型,前者又分为常见型、低连合型、扇叶型和网孔型,其中前隔连合的无连合型、低连合型及网孔型,为超声心动诊断提供了形态学依据,解释了正常人三尖瓣前隔连合处出现有血液返流的现象.三尖瓣基带中的心肌纤维来自心房或心室肌,前者为Purkinje纤维,多见伸至后大瓣;后者为普通心肌纤维,各有一例伸入前尖瓣和隔尖瓣、其中前尖瓣基带中的肌纤维可伸入健索内.

Normal tricuspid valves and their commissures of 35 adult hearts were studied and measuredwith the naked eye, light microscopy and image analysis system. The area of anterior, posterior andseptal leaflets were 445.76±63.54 mm2, 480.54±120.56 mm2, and 361.44±95.07 mm2 respectively.The height of the anteroposterior, posteroseptal and anteroseptal commissures were 9.87±3.82 mm2,6.77±1.64 mm2, and 4.52±2.47mm2 respectively. There were two types of the commissures oftricuspid valve: the joint and unjoint ones. The joint type of the commissures could also be dividedinto ordinary, lower, scalloped and netlike types. The clinical significance of these types of thecommissures are discussed. The myocardial fibers in basal zone of the tricuspid valve continues withthose of the right atrium and ventricle. The myocardial fibers coming from the atrium are Purkinjefibers, which mainly exist in the posterior leaflet. The fibers coming from the ventricle are ordinarymyocardial fibers, which can be seen in the anterior and septal leaflets. The myocardial fibers ofthe anterior leaflet can even be seen in the chordae tendineae.