Pulmonic Valve Anatomy

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The pulmonic valve divides the right ventricular outflow tract from the pulmonary artery. In normal conditions, the pulmonic valve prevents regurgitation of deoxygenated blood from the pulmonary artery back to the right ventricle. It is a semilunar valve with 3 cusps, and it is located anterior, superior, and slightly to the left of the aortic valve.

An image depicting the pulmonary valve can be seen below.

Like the aortic valve, the pulmonic valve is formed by 3 cusps, each with a fibrous node at the midpoint of the free edges (similar to the nodes of Aranti in the aortic valve) as well as lunulae, which are the thin, crescent-shaped portions of the cusps that serve as the coaptive surfaces of the valve. In contrast with the aortic valve, the cusps of the pulmonic valve are supported by freestanding musculature with no direct relationship with the muscular septum; its cusps are much thinner and lack a fibrous continuity with the anterior leaflet of the right atrioventricular (AV) valve (tricuspid valve). ^{[1, 2, 3, 4]}

The cusps of the pulmonic valve are defined by their relationship to the aortic valve and are thus termed anterior or nonseptal, right and left cusps. They can also be defined by their relationship to a commissure found in the pulmonic and aortic valves and hence termed right adjacent (right facing), left adjacent (left facing), and opposite (nonfacing).

The pulmonic valve, like the other 3 cardiac valves, is formed by endocardial folds that are supported by internal plates of dense collagenous and elastic connective tissue and are continuous with the cardiac skeleton. ^[5]

The pathologic variants of the pulmonic valve are more often related to congenital defects rather than to acquired disease, such as rheumatic valve disease or endocarditis.

Pulmonic valvular stenosis (PVS) is the most prevalent pulmonary valve pathology, and it accounts for up to 80% of the cases of right ventricular outflow tract obstruction. This condition can be detected throughout different stages of life, depending on its severity. The more severe the obstruction, the earlier in life, PVS manifests itself. Neonates usually present with critical stenosis, manifested as cyanosis at birth, although infants are usually diagnosed when a murmur auscultated in the pulmonic area. Pulmonic stenosis symptoms tend to worsen and progress with time. Adults usually present with symptoms related to right heart failure.

Goss CM, Gray H. Valves of the heart. Gray’s Anatomy of the Human Body. 29th ed. Philadelphia, Pa: Lea & Febiger; 1973. 543.

Gross L, Kugel MA. Topographic anatomy and histology of the valves in the human heart. Am J Pathol. 1931. 7:445.

Barry A, Patten BM. The structure of the adult heart. Gould SE, ed. Pathology of the heart and blood vessels. 5th ed. Springfield, Ill: Charles C. Thomas; 1968. 91.

Bergman RA, Afifi AK, Heidger PM Jr. Atlas of Microscopic Anatomy. Section 8: Cardiovascular System. Anatomy Atlases. Available at http://www.anatomyatlases.org/MicroscopicAnatomy/Section08/Section08.shtml. Accessed: March 19, 2011.

Kerr A Jr, Goss CM. Retention of embryonic relationship of aortic and pulmonary valve cusps and suggested nomenclature. Anat Rec. 1956. 125:777.

Juan Fernando Biguria, MD Clinical Chief, Cardiovascular Surgery Department, Clínica Santa Elena; Cardiovascular Surgeon, Vithas Xanit International Hospital; Associated Clinical Tutor, Universidad de Malaga Faculty of Medicine, Spain

Juan Fernando Biguria, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Phlebology, European Association for Cardio-Thoracic Surgery, Society for Vascular Surgery, Society of Thoracic Surgeons, Undersea and Hyperbaric Medical Society, World Association for Disaster and Emergency Medicine

Disclosure: Nothing to disclose.

Thomas R Gest, PhD Professor of Anatomy, Department of Medical Education, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Disclosure: Nothing to disclose.

Pulmonic Valve Anatomy

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