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Correspondence  |   October 2004
Learning Aid for Geometric Relations of Cardiac Valves
Author Affiliations & Notes
  • Fumi Handa-Tsutsui, M.D., Ph.D.
    *
  • * St. Luke’s-Roosevelt Hospital Center, New York, New York. .
Article Information
Correspondence
Correspondence   |   October 2004
Learning Aid for Geometric Relations of Cardiac Valves
Anesthesiology 10 2004, Vol.101, 1050-1051. doi:
Anesthesiology 10 2004, Vol.101, 1050-1051. doi:
To the Editor:—
Although transesophageal echocardiography has been integrated into clinical training of anesthesiology, it is not easy to understand the geometric relations of cardiac valves. We suggest use the hands to memorize the geometric relations of four cardiac valves.
Grip both hands in the position M and T as shown in figure 1. The mitral valve is the most posterior cardiac valve, whereas the tricuspid valve is located anterior and to the right of the mitral valve. These two valves are of similar size. The mitral valve has two leaflets (anterior and posterior), and each leaflet has three scallops, from anterolateral to posteromedial (A1, A2, A3, P1, P2, P3). The tricuspid valve has three cusps (anterior, posterior, and septal).
Fig. 1. Schematic drawing of four cardiac valves (anatomic view).  A1, A2, A3: A1, A2, A3  = scallops of anterior mitral valve leaflet;  P1, P2, P3: P1, P2, P3  = scallops of posterior mitral valve leaflet;  Sep  = septal cusp;  Ant  = anterior cusp;  Post  = posterior cusp of the tricuspid valve;  LCC  = left coronary cusp;  RCC  = right coronary cusp;  NCC  = noncoronary cusp of the aortic valve;  A  = anterior cusp;  R  = right cusp of pulmonary valve;  L  = left cusp of pulmonary valve. 
Fig. 1. Schematic drawing of four cardiac valves (anatomic view).  A1, A2, A3: A1, A2, A3  = scallops of anterior mitral valve leaflet;  P1, P2, P3: P1, P2, P3  = scallops of posterior mitral valve leaflet;  Sep  = septal cusp;  Ant  = anterior cusp;  Post  = posterior cusp of the tricuspid valve;  LCC  = left coronary cusp;  RCC  = right coronary cusp;  NCC  = noncoronary cusp of the aortic valve;  A  = anterior cusp;  R  = right cusp of pulmonary valve;  L  = left cusp of pulmonary valve. 
Fig. 1. Schematic drawing of four cardiac valves (anatomic view).  A1, A2, A3: A1, A2, A3  = scallops of anterior mitral valve leaflet;  P1, P2, P3: P1, P2, P3  = scallops of posterior mitral valve leaflet;  Sep  = septal cusp;  Ant  = anterior cusp;  Post  = posterior cusp of the tricuspid valve;  LCC  = left coronary cusp;  RCC  = right coronary cusp;  NCC  = noncoronary cusp of the aortic valve;  A  = anterior cusp;  R  = right cusp of pulmonary valve;  L  = left cusp of pulmonary valve. 
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Move right hand from position T to A as shown in fig. 1. The aortic valve has three cusps (the left coronary cusp, the right coronary cusp, and the noncoronary cusp). The aortic valve is smaller than the mitral valve and is located anterior and to the right of the mitral valve. It attaches to the mitral valve between the noncoronary cusp and the left coronary cusp. The right coronary cusp is the most anterior cusp of the aortic valve.
Move left hand from position M to P, as shown in fig. 1. The pulmonary valve is located to the left and anterior to the aortic valve. It has three cusps (anterior, right, left). It is attached to the aortic valve between its left and right cusp. These two valves are approximately the same size.
These relations can be useful to remember cardiac valves and each structure for transesophageal echocardiography beginners.
* St. Luke’s-Roosevelt Hospital Center, New York, New York. .
Fig. 1. Schematic drawing of four cardiac valves (anatomic view).  A1, A2, A3: A1, A2, A3  = scallops of anterior mitral valve leaflet;  P1, P2, P3: P1, P2, P3  = scallops of posterior mitral valve leaflet;  Sep  = septal cusp;  Ant  = anterior cusp;  Post  = posterior cusp of the tricuspid valve;  LCC  = left coronary cusp;  RCC  = right coronary cusp;  NCC  = noncoronary cusp of the aortic valve;  A  = anterior cusp;  R  = right cusp of pulmonary valve;  L  = left cusp of pulmonary valve. 
Fig. 1. Schematic drawing of four cardiac valves (anatomic view).  A1, A2, A3: A1, A2, A3  = scallops of anterior mitral valve leaflet;  P1, P2, P3: P1, P2, P3  = scallops of posterior mitral valve leaflet;  Sep  = septal cusp;  Ant  = anterior cusp;  Post  = posterior cusp of the tricuspid valve;  LCC  = left coronary cusp;  RCC  = right coronary cusp;  NCC  = noncoronary cusp of the aortic valve;  A  = anterior cusp;  R  = right cusp of pulmonary valve;  L  = left cusp of pulmonary valve. 
Fig. 1. Schematic drawing of four cardiac valves (anatomic view).  A1, A2, A3: A1, A2, A3  = scallops of anterior mitral valve leaflet;  P1, P2, P3: P1, P2, P3  = scallops of posterior mitral valve leaflet;  Sep  = septal cusp;  Ant  = anterior cusp;  Post  = posterior cusp of the tricuspid valve;  LCC  = left coronary cusp;  RCC  = right coronary cusp;  NCC  = noncoronary cusp of the aortic valve;  A  = anterior cusp;  R  = right cusp of pulmonary valve;  L  = left cusp of pulmonary valve. 
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