Annulus Fibrosus of the Mitral Valve: Reality or Myth

Berdajs, Denis; Zünd, Gregor; Camenisch, Colette C.; Schurr, Ulrich; Turina, Marko; Genoni, Michele

doi:10.1111/j.1540-8191.2007.00449.x

Cited by 23 publications

(7 citation statements)

References 7 publications

(8 reference statements)

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“…Some authors have referred to these as "strut" chordae, although the distinction for this qualification is vague. 36,44,51,67,71,73,74 There is substantial chordal-papillary variation with wide geometrical variability in papillary muscle morphology and origin. It is unclear whether this variation affects the state of papillary-annular continuity or left ventricular function.…”

Section: Figurementioning

confidence: 99%

“…2 and 5). 44 When considered 3-dimensionally, the overall atrioventricular junction is nonplanar and approximates a hyperbolic parabola. The geometric shape of the mitral annulus in normal hearts resembles a tilted riding saddle, with the "saddle horn" of the mitral annulus located near the area of aortic-mitral continuity.…”

Section: Epidemiology and Natural Historymentioning

confidence: 99%

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Pathology of myxomatous mitral valve disease in the dog

Fox

2012

Journal of Veterinary Cardiology

118

117

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Section: Figurementioning

confidence: 99%

Section: Epidemiology and Natural Historymentioning

confidence: 99%

Pathology of myxomatous mitral valve disease in the dog

Fox

2012

Journal of Veterinary Cardiology

118

117

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“…6,7 Surgical repair of the mitral valve is, in most cases, limited to the posterior leaflet and the annulus fibrosis. 26 The annulus fibrosis is sometimes not a ringlike structure but only a fibrous band between the mitral valve and the left ventricle; 26 in such cases the risk of injuring the AV node artery is increased.…”

Section: 25mentioning

confidence: 99%

Anatomical Aspects of the Arterial Blood Supply to the Sinoatrial and Atrioventricular Nodes of the Human Heart

et al. 2008

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Classic anatomical dissection of 150 hearts from adults aged 18 -80 years was performed. The sinoatrial (SA) node artery was most frequently a large atrial branch of the right coronary artery (63%), arising at a mean distance of 1.2 cm (range 0.2 -2.2 cm) from its beginning, with a mean external diameter of 1.7 mm (range 1 -3 mm). In 37% of cases the SA node artery was a branch of the left coronary artery or one of its branches, with an initial mean external diameter of 2.2 mm (range 2 -3 mm). The origin of the SA node artery was not related to coronary arterial dominance. The atrioventricular (AV) node artery was the first and longest inferior septal perforating branch of the right (90%) or left (10%) coronary artery, arising from the U-or Vshaped segment of the corresponding artery at the level of the crux cordis. Mean external diameter was 2 mm (range 1 -3.5 mm). The origin of the AV node artery was dependent on coronary arterial dominance. Identification of the anatomical variants of the arterial blood supply to the SA and AV nodes may help in overcoming potential difficulties in treating arrhythmias and in mitral valve surgery.

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“…10,11 These measurements have been found to be highly accurate when compared with direct intraoperative measurements and are highly reproducible, ensuring that changes in serial measurements reflect true changes and not differences in interpreter measurement techniques. 3,8,12 In addition, these measurements provide considerable mechanistic insight into the complex annular alterations that occur in degenerative and ischemic mitral valve disease and the conformational changes that occur in both the mitral and aortic annuli with mitral valve repair.…”

Section: D Echocardiography Improves Lesion Localization and Quantifmentioning

confidence: 99%

Three-dimensional Echocardiography Is Essential for Intraoperative Assessment of Mitral Regurgitation

Tsang

Lang²

2013

Circulation

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Since its introduction, 3-dimensional (3D) transesophageal echocardiography (TEE) has become widely adopted in operating rooms and cardiac catheterization laboratories worldwide. This is because the matrix-array 3D TEE probe allows acquisition of high-quality 3D images in real time with relatively little training. The rapid adoption of this technology has proven that this innovative imaging modality provides additional clinical information beyond that obtained from 2-dimensional (2D) TEE images. These developments have enabled medical centers to create integrated valve programs in which surgeons, interventionalists, and echocardiographers discuss cases and surgical approaches. Response by McCarthy on p 652In particular, 3D TEE has been proven to be superior to 2D TEE in the assessment of both mitral valve anatomy and mitral regurgitation, promoting its use in the operating room (Table 1). [1][2][3] One reason for this superiority is that 3D TEE allows the mitral valve to be displayed en face in an orientation identical to the surgeon's view of the mitral valve intraoperatively. This surgeon's view greatly facilitates communication with cardiac surgeons because they can easily interpret these images.Here, we argue that the widespread acceptance and use of 3D TEE are attributable to the pivotal role this modality plays in the intraoperative assessment of mitral regurgitation. We believe that 3D TEE of the mitral valve is invaluable not only because of the realistic images it provides but also because it improves: 1) lesion localization, 2) identification of the mechanisms causing mitral regurgitation, 3) quantification of the severity of mitral regurgitation, 4) selection of surgical intervention, 5) the choice of the surgeon whose expertise is best suited to perform the operation, 6) guidance of percutaneous mitral valve procedures, and 7) postoperative assessment. 3D Echocardiography of the Mitral ValveAccurate preoperative assessment of the mitral valve is critical in the surgical management of patients with severe mitral regurgitation. This information determines whether the patient should undergo valve repair or replacement, which has implications in terms of timing of surgery and long-term morbidity and mortality. 4 Traditionally, 2D TEE has been used to evaluate mitral valve anatomy. However, 2D TEE requires manual manipulation of the transducer in the esophagus and various degrees of flexion or anteflexion of the probe to acquire the standard mid-esophageal views and to examine all leaflet scallops. Since 2D TEE only provides single plane images, the entire mitral annulus and leaflets are not displayed in a single en face view, making it difficult to identify specific scallops with precision. As well, because the mitral annulus is saddle shaped, distortions of mitral valve anatomy, mitral annular dilatation, or aortic root enlargement may change the orientation of the ultrasound plane in relation to mitral valve apparatus, resulting in scallop misidentification.

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Annulus Fibrosus of the Mitral Valve: Reality or Myth

Cited by 23 publications

References 7 publications

Pathology of myxomatous mitral valve disease in the dog

Pathology of myxomatous mitral valve disease in the dog

Anatomical Aspects of the Arterial Blood Supply to the Sinoatrial and Atrioventricular Nodes of the Human Heart

Three-dimensional Echocardiography Is Essential for Intraoperative Assessment of Mitral Regurgitation

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