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. 2018 Nov-Dec;70(6):894-900.
doi: 10.1016/j.ihj.2017.12.003. Epub 2017 Dec 11.

Papillary muscles of left ventricle-Morphological variations and it's clinical relevance

Anubha Saha  1 , Sanchita Roy  2
Affiliations

Papillary muscles of left ventricle-Morphological variations and it's clinical relevance

Anubha Saha et al. Indian Heart J. 2018 Nov-Dec.

Abstract

Introduction: The two left ventricular papillary muscles are small structures at sternocostal and inferior wall but are vital to mitral valve competence. Extra papillary muscles could be found. Partial or complete rupture, complicating acute myocardial infarction, causes severe or even catastrophic mitral regurgitation, potentially correctable by surgery. Detailed knowledge of normal anatomy and variations is vital for accurate interpretation of information by echocardiography and for surgical repair.

Materials and methods: The material for present study consisted of 52 formalin fixed adult apparently normal cadaveric hearts belonging to either sex obtained from the Department of Anatomy. These hearts were dissected carefully to open the left ventricle and to expose the papillary muscles. According to their attitudinal position they were described as supero-lateral (S-L) and inferoseptal muscle (I-S) instead of conventional anterolateral and posteromedial. Different morphological features of papillary muscles were noted and measurements were taken.

Results: Classical picture of left ventricular papillary muscle was found only in 25% cases. Additionally extra muscles were found 34.61% and 71.15% in S-L and I-S group, respectively. Different shapes and pattern of papillary muscles were also been identified. An additional attribute of this study was measurement of length and breadth of papillary muscles which thus provides a base line data for further detailed studies in a large scale.

Conclusion: Oriental nomenclature is necessary not only for anatomist but also for electrocardiographers. Breadth of papillay muscle should be taken into morphometric account as for screening of hypertrophic cardiomyopathy. Proper anatomical knowledge is crucial for clinicians, surgeons and radiologists.

Keywords: Heart; Left ventricle; Mitral valve; Papillary muscles.

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Figures

None
Graphical abstract
Fig. 1
Fig. 1
1(a) Sternocostal surface reflected medially. 1(b) Sternocostal surface reflected laterally. 1-S-L papillary muscle from sternocostal surface, 2-I-S papillary muscle from diaphragmatic surface, 3- Sternocostal surface, 4- Diaphragmatic surface.
Fig. 2
Fig. 2
2(a) Double parallel S-L(1,2) and I-S(3,4)papillary muscles. 1-Conical, 2-Truncated, 3- Trifurcated, 4- Flattop. 2(b) Double parallel S-L(1,2) and single I-S(3)papillary muscles. 1-Conical, 2-Truncated, 3- Bifurcated. U1/3–Upper ⅓ of ventricular wall; M1/3 − Middle⅓ of ventricular wall.
Fig. 3
Fig. 3
3(a) Single S-L(1) and Double parallel (2,3)papillary muscles. 1–Truncated, 2–Truncated, 3–Conical. M1/3–Middle ⅓ of ventricular wall. 3(b) Single S-L(1) and Triple interconnected I-S. (2,3,4)papillary muscles 1–Truncated, 2–Flattop, 3 & 4–Conical.
Fig. 4
Fig. 4
4(a) Double S-L (1,2) and Quintuple I-S(3,4,5,6&7)papillary muscles. 1 & 2–Interconnected, 3 & 4–Interconnected, 5–Separated, 6 & 7–Interconnected, 3- attached with both cusps, 4 & 5–attached with only posterior cusp. 3 & 4–Lower ⅓ of ventricular wall origin, 5–Middle ⅓ of ventricular wall origin, 6 & 7–Upper ⅓ of ventricular wall origin. 4(b) Single S-L and Double parallel I-S(2,3)papillary muscles. 1–Conical muscle from Middle ⅓ (M1/3) of ventricular wall attached with both cusps. 2 & 3–Conical muscles from Lower⅓ (L1/3) of ventricular wall attached with both cusps.
Fig. 5
Fig. 5
Comparison of present and previous study reports regarding muscles origin from ventricular walls.
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