The tricuspid valve is a trileaflet structure consisting of anterior, posterior and septal leaflets, the anterior leaflet being the largest and posterior leaflet being the smallest (Fig. 6.13). The tricuspid valve leaflets have primary, secondary and tertiary chordae and papillary muscles. There is a single large anterior papillary muscle attached to the free wall and several accessory papillary muscles attached to the septum. The septal leaflet is fixed. The AV node and bundle of His run through the triangle of Koch, the borders of which are defined by the tendon of Todaro, the annulus of the tricuspid valve and the coronary sinus. The closest region between the annulus and the conduction tissue is where the bundle of His lies adjacent to the anterior and septal portions of the tricuspid valve; this is the area in most danger of injury to the conduction tissue.


Tricuspid valve disease is only rarely from tricuspid stenosis. When it is, it is nearly always of rheumatic etiology. Much more commonly, tricuspid disease is

Fig. 6.13. Tricuspid valve and its relationship to the AV node and Bundle of His. Danger points for injury to AV node and bundle of His indicated by row of Xs.

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