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Review
. 2002 Nov;88 Suppl 4(Suppl 4):iv5-10.
doi: 10.1136/heart.88.suppl_4.iv5.

Anatomy of the mitral valve

S Y Ho  1
Affiliations
Review

Anatomy of the mitral valve

S Y Ho. Heart. 2002 Nov.
No abstract available

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Figures

Figure 1
Figure 1
(A) View of the base of the heart in anatomical orientation shows the spatial relations of the four cardiac valves. The left heart valves are close together whereas the right heart valves are separated by myocardium. Dotted line marks the limit of atrial myocardium around the mitral orifice. (B) This dissection of the heart viewed from the anterior aspect shows the close relation between aortic and mitral valves in situ. Fibrous continuity between the valves (blue arrows) is related to the non- and left coronary sinuses of the aorta.
Figure 2
Figure 2
(A) The left parietal atrioventricular junction in profile shows the left atrial wall (blue arrows) running to the hinge (red arrow) of the mural leaflet of the mitral valve. (B) The aortic leaflet of the mitral valve cut in profile shows the atrial wall (blue arrows) reaching the leaflet. Grey dots mark the region of fibrous continuity between aortic and mitral valves.
Figure 3
Figure 3
A dissection showing the left (L) and right (R) fibrous trigones revealed by removing the left and non-coronary aortic sinuses. The trigones are expansions of fibrous tissue at either end of the area of aortic–mitral valvar continuity. The right fibrous trigone together with the membranous septum forms the central fibrous body. The diagrams represent two of the cases reported in the work by Angelini and colleagues.5 They show the variation in completeness of the so-called valvar annulus (green areas).
Figure 4
Figure 4
(A) The atrial aspect of the mitral valve shows the arrangement of the two leaflets between the commissures. The free edge of the mural leaflet has two clefts (red arrows) giving this leaflet the appearance of three scallops. Note the wider middle scallop. (B) The aortic leaflet of the mitral valve hangs between inflow and outflow tracts of the left ventricle. Aortic–mitral fibrous continuity (dotted line) extends between the membranous septum (dotted circle) and the left fibrous trigone.
Figure 5
Figure 5
(A) Atrial surface (upper panel) and ventricular surface (lower panel) of a mitral valve spread open by cutting through the mural leaflet. The red arrows indicate the commissures supported by fan shaped commissural cords that are difficult to distinguish from cleft cords (blue arrows). Note the attachment of the cords to the edge and the rough zone of the leaflets. The broken line on the aortic leaflet marks the border between clear and rough zones. (B) This dissection profiling the aortic leaflet shows cordal attachments to the rough zone. (C) A basal cord inserts to the basal zone on the ventricular surface of the mural leaflet, close to its hinge.
Figure 6
Figure 6
(A) The closure line of the mitral valve is seen in this simulated two chamber section through the long axis of the left ventricle. The closure line is below the level of the atrioventricular junction (broken line). (B) A case of prolapse of the middle scallop (arrow) in the mural leaflet overshooting above the level of the atrioventricular junction (broken line) when the valve closes. Note also the dome-like protrusions on the aortic leaflet. (C) Rupture of the tip of a papillary muscle affecting the aortic leaflet.
Figure 7
Figure 7
(A) Rheumatic mitral valve viewed from the atrium showing the stenotic crescent shaped orifice owing to fusion of the leaflets at the commissures (▿). (B) This longitudinal section through a rheumatic mitral valve shows fusion at the commissures (▿) and thickening of the leaflets. (C) A single group of papillary muscles supports this parachute mitral valve. Note the short cords and loss of intercordal spaces exacerbating valvar stenosis.
Figure 8
Figure 8
(A) Short axis section through the ventricles showing the oblique arrangement of the anterolateral (AL) and posteromedial (PM) papillary muscles. (B) This section nearer to the base shows the aortic outlet (arrow) sandwiched between the mitral valve and the septum.
Figure 9
Figure 9
The diagram shows the planes of longitudinal sections through the mitral valve. The parasternal two chamber plane (P2) passes through the middle of both leaflets along the minor axis of the valve whereas the apical two chamber plane (A2) is at an angle to it. The apical four chamber plane (A4) is nearly parallel to the zone of apposition. (A) This simulated parasternal long axis section profiles the two leaflets nicely. (B) This simulated four chamber plane cuts the leaflets obliquely. It shows the aortic leaflet toward the posteromedial commissure and the mural leaflet toward the anterolateral commissure.
Figure 10
Figure 10
Sections A, B, and C are a series of heart sections replicating transgastric echocardiographic cuts of four chamber views foreshortened at the cardiac apex that allow visualisation of the tendinous cords and papillary muscles. Section A shows the off-set arrangement between tricuspid and mitral valves at the septum. Section B is a cut through the membranous septum (▿) and shows the papillary muscles. Sections D and E replicate transgastric cuts through the closure line of the mitral leaflets that allow examination of the anterolateral (AL) and posteromedial (PM) commissures. LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.
See this image and copyright information in PMC

References

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