Papillary muscle–left ventricular wall “complex”

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Papillary muscle–left ventricular wall “complex” Masashi Komeda, MD, PhDa, Julie R. Glasson, MDa, Ann F. Bolger, MDb,c, George T. Daughters II, MSd, Neil B. Ingels Jr, PhDd, D.Craig Miller, MDa,c The Journal of Thoracic and Cardiovascular Surgery Volume 113, Issue 2, Pages 292-301 (February 1997) DOI: 10.1016/S0022-5223(97)70326-X Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 1 A, Marker array in the left ventricle, PMs, and the mitral anulus. B, A cylindrical coordinate system. A, LV markers were placed subepicardially and annular markers were sewn through a left atriotomy with the animal supported by on CPB. Black squares illustrate the markers on the PM bases and black diamonds show the markers on the PM tips. B, The “midpoint” between the anterior commissure and posterior commissure markers serves as the origin of the reference system; the line from the origin to the LV apex is the z-axis. APM, Anterior PM; PPM, posterior PM; LV, left ventricular; ACOM, anterior commissure; PCOM, posterior commissure. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 292-301DOI: (10.1016/S0022-5223(97)70326-X) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 Time-course of change as a function of time of the z-coordinate of the tip and base of the anterior PM (APM) and the length of the APM throughout one cardiac cycle during the following conditions: [1] baseline, [2] reduced LV preload by vena caval occlusion (VCO), [3] lowered reduced LV afterload by infusion of sodium nitroprusside (SNP), and [4] tachycardia using atrial pacing. The X axis of each graph indicates the 10 time points during the cardiac cycle, and the Y axis depicts the z-coordinate of the APM tip or base and the length of the APM (millimeters, mean ± 1 standard deviation). Systole and diastole were both divided into five equal time interval segments. The leftmost panel indicates baseline conditions; sequentially moving to the right, VCO, SNP, and pacing data are portrayed. Note that the APM tip z-coordinate was nearly constant throughout the cardiac cycle and that this pattern did not change during the various LV loading conditions; conversely, the z-coordinate of the APM base as well as APM length varied considerably with time during the cardiac cycle and during VCO. *p < 0.005 versus baseline at the individual time points denoted (paired t tests). The Journal of Thoracic and Cardiovascular Surgery 1997 113, 292-301DOI: (10.1016/S0022-5223(97)70326-X) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 Relative change (expressed as a percentage) with respect to time of the z-coordinate of the tip and base of the anterior PM (APM) and the length of the APM in one representative cardiac cycle during the four conditions (each time point vs end-diastole). Note that the relative change of the z-coordinate of the APM tip oscillated around zero (i.e., was nearly constant); the APM base z-coordinate changed during the cardiac cycle, and the length of the APM varied even more compared with the z-coordinate of the APM base (percent, mean ± 1 standard deviation). This pattern was similar for all four LV loading conditions: [1] baseline, [2] vena cava occlusion [VCO], [3] sodium nitroprusside [SNP], and [4] tachycardia (pacing). The Journal of Thoracic and Cardiovascular Surgery 1997 113, 292-301DOI: (10.1016/S0022-5223(97)70326-X) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 4 Time-course of change of the z-coordinate of the tip and base of the posterior PM (PPM) and the length of the PPM for one typical cardiac cycle during with the following conditions: [1] baseline, [2] reduced preload by vena caval occlusion (VCO), [3] lowered afterload by infusion of sodium nitroprusside (SNP), and [4] tachycardia by atrial pacing. The z-coordinate of the PPM tip was nearly constant throughout the cardiac cycle compared with the z-coordinate of the PPM base and PPM length, which varied considerably (millimeters, mean ± 1 standard deviation). As LV loading conditions were altered, this pattern did not change. *p < 0.005 versus baseline at the individual time points indicated by t test for paired comparison. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 292-301DOI: (10.1016/S0022-5223(97)70326-X) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 5 Fractional or relative change as a function of time of the posterior PM (PPM) tip and base z-coordinates and the PPM length over one representative in one cardiac cycle during the same four LV loading conditions indicated in Figs. 2 to 4 (each time point versus end-diastole). Notice that the relative motion of the z-coordinate of the relative PPM tip was close to zero whereas the PPM base z-coordinate changed considerably more and the PPM length even more over time (percent, mean ± 1 standard deviation). The pattern seen in the baseline measurements (left panel) was similar to that during the other three conditions. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 292-301DOI: (10.1016/S0022-5223(97)70326-X) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 6 “J-shaped complex.” This complex consists of a descending limb consisting of the LV wall and an ascending limb (the PM). Both limbs should work together in balance to maintain a stable distance between the PM tip and the mitral anulus. If one component sustains injury or ischemia, the functional integrity of the J-shaped complex could be lost and abnormal mitral valve dynamics and geometry result. APM, Anterior papillary muscle; PPM, posterior papillary muscle. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 292-301DOI: (10.1016/S0022-5223(97)70326-X) Copyright © 1997 Mosby, Inc. Terms and Conditions