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Surgical
Anatomy of the Mitral Valve
The diagram at the left views the mitral valve from the rear.
Note there are two papillaries. |
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The posterior
leaflet is the widest around the annulus and divided into three
scallops, P1, P2, P3. P1 is adjacent to the antero-lateral commissure
and is closest to the aorta (anterior). The opposing sections
of the anterior leaflet are designated A1, A2 and A3. Thus,
there are eight places for functional abnormalities to occur
(two commissures and 6 of the previously noted leaflet sections). |
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The mitral
annulus is opened and viewed from posteriorly. Note the three
scallops of the posterior leaflet. |
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A fresh
porcine heart is opened to show the same anatomy depicted in
the diagram of the previous figure. |
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The functional
segments shown from the surgical approach (left) and the chest
wall (right). Surgery views things from above (the left atrium)
and echo from below. Note the position of the aorta to help
orient the most anterior commissure and thus, P1. |
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The mitral
valve functional segments viewed by echo (from below). Note
the aortic position to help identify segments. The right shows
a pathologic section depicting the echo view. |
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The two
echo views. From the chest wall (left) and the TEE approach
(right). Note the position of the aorta to help orient the most
anterior commissure and thus, P1. |
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Pathology
Pathologic specimen showing the ventricular
side of a St. Jude’s prostheses with vegetative growths (left).
The right shows the same specimen from the atrial surface showing
a vegetation through the prostheses (arrow). |
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Pathologic
specimen of the mitral valve cut from the side. Note the scallops
and compare to the diagrams and specimens in the section on
anatomy. The arrow points to a vegetation on chords of the posterior
mitral valve leaflet (P3 segment). |
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Pathologic
speciment of the mitral valve cut from the side in a patient
with typical mitral valve prolapse. The leaflets are thickened
(arrow).
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Pathologic
specimen of the mitral valve cut from the side in a patient
with broken mitral chordae (arrow). The chords segment shown
has ruptured chords to P1. |
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Pathologic
specimen of the mitral valve cut from the side in a patient
with typical rheumatic mitral stenosis. The leaflets are thickened
and the chordae are shortened. |
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Even more
severe mitral stenosis in comparison to the previous figure.
The arrow points to severe chordal thickening and shortening.
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An eroded
mitral valve leaflet from bacterial endocarditis (arrow). Where
is the erosion. Answer is at the base of P2. The pathologic
specimen is cut from the side. |
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Severe
dysplastic changes of the posterior mitral leaflet (arrow).
Note the leaflets and chordae are indistinct. |
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A mitral
valve specimen shown cut from the side. Which is the anterior
mitral leaflet. Correct answer is at the right hand side. Not
it is the longest in length, but the narrowest around the annulus.
The mitral morphology is normal. See the next figure. |
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A short
axis of the left ventricle from the patient shown in the previous
figure. While the morphology of the mitral valve was normal,
note the significant wall thinning a the bottom that followed
an infarction. This patient has severe MR with failure to coapt. |
2004