Petra W. Oosthoek, PhDa, Arnold C. G. Wenink, MD, PhDa, António J

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Presentation transcript:

The parachute-like asymmetric mitral valve and its two papillary muscles Petra W. Oosthoek, PhDa, Arnold C.G. Wenink, MD, PhDa, António J. Macedo, MDb, Adriana C. Gittenberger-de Groot, PhDa The Journal of Thoracic and Cardiovascular Surgery Volume 114, Issue 1, Pages 9-15 (July 1997) DOI: 10.1016/S0022-5223(97)70111-9 Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 1 A schematic drawing (a) and a photograph (b) of a normal mitral valve from a newborn child. The orifice is indicated by dots (a) and by a thick arrow (b). A, Anterolateral papillary muscle; Ao, aorta; P, posteromedial papillary muscle. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 9-15DOI: (10.1016/S0022-5223(97)70111-9) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 1 A schematic drawing (a) and a photograph (b) of a normal mitral valve from a newborn child. The orifice is indicated by dots (a) and by a thick arrow (b). A, Anterolateral papillary muscle; Ao, aorta; P, posteromedial papillary muscle. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 9-15DOI: (10.1016/S0022-5223(97)70111-9) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 Schematic drawing of a mitral valve in which the parts that were measured are indicated by arrows (numbers identified in the Material and methods section). The Journal of Thoracic and Cardiovascular Surgery 1997 114, 9-15DOI: (10.1016/S0022-5223(97)70111-9) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 The spectrum of parachute-like asymmetric mitral valves. a through c, Grade I asymmetric mitral valves demonstrating elongated anterolateral papillary muscles (cases 2 and 4). d through f, Asymmetric grade II mitral valves with only a few chords attached to the elongated anterolateral papillary muscle (cases 11 and 16). g through i, Asymmetric grade III mitral valves with the valve leaflet directly attached to the anterolateral papillary muscle (cases 24 and 25). The mitral valve orifices are indicated by dots in the drawings and by thick arrows on the photomicrographs. Thin arrows indicate chordal attachments and arrowheads indicate direct attachment of the valve leaflet to the anterolateral papillary muscle. A, Anterolateral papillary muscle; Ao, aorta; P, posteromedial papillary muscle. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 9-15DOI: (10.1016/S0022-5223(97)70111-9) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 The spectrum of parachute-like asymmetric mitral valves. a through c, Grade I asymmetric mitral valves demonstrating elongated anterolateral papillary muscles (cases 2 and 4). d through f, Asymmetric grade II mitral valves with only a few chords attached to the elongated anterolateral papillary muscle (cases 11 and 16). g through i, Asymmetric grade III mitral valves with the valve leaflet directly attached to the anterolateral papillary muscle (cases 24 and 25). The mitral valve orifices are indicated by dots in the drawings and by thick arrows on the photomicrographs. Thin arrows indicate chordal attachments and arrowheads indicate direct attachment of the valve leaflet to the anterolateral papillary muscle. A, Anterolateral papillary muscle; Ao, aorta; P, posteromedial papillary muscle. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 9-15DOI: (10.1016/S0022-5223(97)70111-9) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 The spectrum of parachute-like asymmetric mitral valves. a through c, Grade I asymmetric mitral valves demonstrating elongated anterolateral papillary muscles (cases 2 and 4). d through f, Asymmetric grade II mitral valves with only a few chords attached to the elongated anterolateral papillary muscle (cases 11 and 16). g through i, Asymmetric grade III mitral valves with the valve leaflet directly attached to the anterolateral papillary muscle (cases 24 and 25). The mitral valve orifices are indicated by dots in the drawings and by thick arrows on the photomicrographs. Thin arrows indicate chordal attachments and arrowheads indicate direct attachment of the valve leaflet to the anterolateral papillary muscle. A, Anterolateral papillary muscle; Ao, aorta; P, posteromedial papillary muscle. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 9-15DOI: (10.1016/S0022-5223(97)70111-9) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 The spectrum of parachute-like asymmetric mitral valves. a through c, Grade I asymmetric mitral valves demonstrating elongated anterolateral papillary muscles (cases 2 and 4). d through f, Asymmetric grade II mitral valves with only a few chords attached to the elongated anterolateral papillary muscle (cases 11 and 16). g through i, Asymmetric grade III mitral valves with the valve leaflet directly attached to the anterolateral papillary muscle (cases 24 and 25). The mitral valve orifices are indicated by dots in the drawings and by thick arrows on the photomicrographs. Thin arrows indicate chordal attachments and arrowheads indicate direct attachment of the valve leaflet to the anterolateral papillary muscle. A, Anterolateral papillary muscle; Ao, aorta; P, posteromedial papillary muscle. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 9-15DOI: (10.1016/S0022-5223(97)70111-9) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 The spectrum of parachute-like asymmetric mitral valves. a through c, Grade I asymmetric mitral valves demonstrating elongated anterolateral papillary muscles (cases 2 and 4). d through f, Asymmetric grade II mitral valves with only a few chords attached to the elongated anterolateral papillary muscle (cases 11 and 16). g through i, Asymmetric grade III mitral valves with the valve leaflet directly attached to the anterolateral papillary muscle (cases 24 and 25). The mitral valve orifices are indicated by dots in the drawings and by thick arrows on the photomicrographs. Thin arrows indicate chordal attachments and arrowheads indicate direct attachment of the valve leaflet to the anterolateral papillary muscle. A, Anterolateral papillary muscle; Ao, aorta; P, posteromedial papillary muscle. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 9-15DOI: (10.1016/S0022-5223(97)70111-9) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 The spectrum of parachute-like asymmetric mitral valves. a through c, Grade I asymmetric mitral valves demonstrating elongated anterolateral papillary muscles (cases 2 and 4). d through f, Asymmetric grade II mitral valves with only a few chords attached to the elongated anterolateral papillary muscle (cases 11 and 16). g through i, Asymmetric grade III mitral valves with the valve leaflet directly attached to the anterolateral papillary muscle (cases 24 and 25). The mitral valve orifices are indicated by dots in the drawings and by thick arrows on the photomicrographs. Thin arrows indicate chordal attachments and arrowheads indicate direct attachment of the valve leaflet to the anterolateral papillary muscle. A, Anterolateral papillary muscle; Ao, aorta; P, posteromedial papillary muscle. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 9-15DOI: (10.1016/S0022-5223(97)70111-9) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 The spectrum of parachute-like asymmetric mitral valves. a through c, Grade I asymmetric mitral valves demonstrating elongated anterolateral papillary muscles (cases 2 and 4). d through f, Asymmetric grade II mitral valves with only a few chords attached to the elongated anterolateral papillary muscle (cases 11 and 16). g through i, Asymmetric grade III mitral valves with the valve leaflet directly attached to the anterolateral papillary muscle (cases 24 and 25). The mitral valve orifices are indicated by dots in the drawings and by thick arrows on the photomicrographs. Thin arrows indicate chordal attachments and arrowheads indicate direct attachment of the valve leaflet to the anterolateral papillary muscle. A, Anterolateral papillary muscle; Ao, aorta; P, posteromedial papillary muscle. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 9-15DOI: (10.1016/S0022-5223(97)70111-9) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 The spectrum of parachute-like asymmetric mitral valves. a through c, Grade I asymmetric mitral valves demonstrating elongated anterolateral papillary muscles (cases 2 and 4). d through f, Asymmetric grade II mitral valves with only a few chords attached to the elongated anterolateral papillary muscle (cases 11 and 16). g through i, Asymmetric grade III mitral valves with the valve leaflet directly attached to the anterolateral papillary muscle (cases 24 and 25). The mitral valve orifices are indicated by dots in the drawings and by thick arrows on the photomicrographs. Thin arrows indicate chordal attachments and arrowheads indicate direct attachment of the valve leaflet to the anterolateral papillary muscle. A, Anterolateral papillary muscle; Ao, aorta; P, posteromedial papillary muscle. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 9-15DOI: (10.1016/S0022-5223(97)70111-9) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 The spectrum of parachute-like asymmetric mitral valves. a through c, Grade I asymmetric mitral valves demonstrating elongated anterolateral papillary muscles (cases 2 and 4). d through f, Asymmetric grade II mitral valves with only a few chords attached to the elongated anterolateral papillary muscle (cases 11 and 16). g through i, Asymmetric grade III mitral valves with the valve leaflet directly attached to the anterolateral papillary muscle (cases 24 and 25). The mitral valve orifices are indicated by dots in the drawings and by thick arrows on the photomicrographs. Thin arrows indicate chordal attachments and arrowheads indicate direct attachment of the valve leaflet to the anterolateral papillary muscle. A, Anterolateral papillary muscle; Ao, aorta; P, posteromedial papillary muscle. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 9-15DOI: (10.1016/S0022-5223(97)70111-9) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 4 A schematic drawing (a) and a photograph (b) of the single parachute mitral valve with one papillary muscle to which all chords are attached. The mitral valve orifice is indicated by dots (a) and by a thick arrow (b). Ao, Aorta. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 9-15DOI: (10.1016/S0022-5223(97)70111-9) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 4 A schematic drawing (a) and a photograph (b) of the single parachute mitral valve with one papillary muscle to which all chords are attached. The mitral valve orifice is indicated by dots (a) and by a thick arrow (b). Ao, Aorta. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 9-15DOI: (10.1016/S0022-5223(97)70111-9) Copyright © 1997 Mosby, Inc. Terms and Conditions