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Published online: 2024-06-03

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Morphometric evaluation of the left atrioventricular valve complex and its clinical relations

Buse Naz Çandır12, Çağla Ergin3, Kader Yılar1, Osman Coşkun1, Erdoğan Kara3, Ayşin Kale1, Nilgün Bozbuğa4, Adnan Öztürk25, Özcan Gayretli1
Pubmed: 38842077


Background: In this study, it was aimed to evaluate morphometrically and morphologically the left fibrous ring, mitral leaflets, tendinous cords, and papillary muscles, which are the components of the left atrioventricular valve complex (LAVC), and to reveal their clinical relationships.

Materials and methods: A total of 120 human hearts were examined at the Forensic Medicine Institute. Cases aged 30 years and older, less than 24 hours after their death, were included in the study. Heart length, width, height/width ratio, anteroposterior and mediolateral diameters of the annulus, annular area, length and width of leaflets, number and attachment sites of tendinous cords, number, shape, length, the width of papillary muscles, and distances to various points were recorded to determine their spatial configurations. As well as the measurement data of LAVC components in cases with and without cardiovascular disease (CVD), the relationships of these data with the demographic characteristics of the cases are also explained.

Results: In the diagnostic performance test (ROC analysis), it was determined that body mass index (> 26.7), heart weight (> 414 g), heart height/width ratio (≤ 1.24), mitral valve width (> 99.96 mm), left ventricular wall thickness (> 15.08 mm), annular area (> 619.37 mm2) and mediolateral diameter of the annulus (> 30.71 mm) are important diagnostic criteria in determining CVD if they are outside the specified reference values.

Conclusions: This study provides anatomical information about LAVC, as well as recommendations for diagnosis and surgical treatment planning. We therefore believe that our findings will be useful to clinicians.

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  1. Al-Azizi K, Szerlip M. Mitral stenosis after mitraclip: how to avoid and how to treat. Curr Cardiol Rep. 2020; 22(7): 50.
  2. Baxi AJ, Restrepo CS, Vargas D, et al. Hypertrophic cardiomyopathy from A to Z: genetics, pathophysiology, imaging, and management. Radiographics. 2016; 36(2): 335–354.
  3. Bhadoria P, Bisht K, Singh B, et al. Cadaveric study on the morphology and morphometry of heart papillary muscles. Cureus. 2022; 14(2): e22722.
  4. Carpentier A, Branchini B, Cour JC, et al. Congenital malformations of the mitral valve in children. J Thorac Cardiovasc Surg. 1976; 72(6): 854–866.
  5. Dal-Bianco JP, Levine RA. Anatomy of the mitral valve apparatus: role of 2D and 3D echocardiography. Cardiol Clin. 2013; 31(2): 151–164.
  6. Faletra FF, Leo LA, Paiocchi VL, et al. Anatomy of mitral annulus insights from non-invasive imaging techniques. Eur Heart J Cardiovasc Imaging. 2019; 20(8): 843–857.
  7. Flachskampf FA, Chandra S, Gaddipatti A, et al. Analysis of shape and motion of the mitral annulus in subjects with and without cardiomyopathy by echocardiographic 3-dimensional reconstruction. J Am Soc Echocardiogr. 2000; 13(4): 277–287.
  8. Freedman JE. Circulation research. Circ Res. 2019; 125(1): 5–6.
  9. Gunnal SA, Wabale RN, Farooqui MS, et al. Morphological variations of papillary muscles in the mitral valve complex in human cadaveric hearts. Singapore Med J. 2013; 54(1): 44–48.
  10. Kim K, Kaji S, An Y, et al. Interpapillary muscle distance independently affects severity of functional mitral regurgitation in patients with systolic left ventricular dysfunction. J Thorac Cardiovasc Surg. 2014; 148(2): 434–440.e1.
  11. Krawczyk-Ożóg A, Hołda MK, Bolechała F, et al. Anatomy of the mitral subvalvular apparatus. J Thorac Cardiovasc Surg. 2018; 155(5): 2002–2010.
  12. Krawczyk-Ożóg A, Hołda MK, Sorysz D, et al. Morphologic variability of the mitral valve leaflets. J Thorac Cardiovasc Surg. 2017; 154(6): 1927–1935.
  13. Lai DT, Tibayan FA, Myrmel T, et al. Mechanistic insights into posterior mitral leaflet inter-scallop malcoaptation during acute ischemic mitral regurgitation. Circulation. 2002; 106(12 Suppl 1): I40–I45.
  14. Lee PT, Dweck MR, Prasher S, et al. Left ventricular wall thickness and the presence of asymmetric hypertrophy in healthy young army recruits: data from the LARGE heart study. Circ Cardiovasc Imaging. 2013; 6(2): 262–267.
  15. McCarthy KP, Ring L, Rana BS. Anatomy of the mitral valve: understanding the mitral valve complex in mitral regurgitation. Eur J Echocardiogr. 2010; 11(10): i3–i9.
  16. Messika-Zeitoun D, Nickenig G, Latib A, et al. Transcatheter mitral valve repair for functional mitral regurgitation using the Cardioband system: 1 year outcomes. Eur Heart J. 2019; 40(5): 466–472.
  17. Mohammadi S, Hedjazi A, Sajjadian M, et al. Study of the normal heart size in Northwest part of Iranian population: a cadaveric study. J Cardiovasc Thorac Res. 2016; 8(3): 119–125.
  18. Mrsic Z, Hopkins SP, Antevil JL, et al. Valvular heart disease. Prim Care. 2018; 45(1): 81–94.
  19. Muresian H. The clinical anatomy of the mitral valve. Clin Anat. 2009; 22(1): 85–98.
  20. Oliveira D, Srinivasan J, Espino D, et al. Geometric description for the anatomy of the mitral valve: a review. J Anat. 2020; 237(2): 209–224.
  21. Saha A, Roy S. Papillary muscles of left ventricle-morphological variations and it's clinical relevance. Indian Heart J. 2018; 70(6): 894–900.
  22. Sakai T, Okita Y, Ueda Y, et al. Distance between mitral anulus and papillary muscles: anatomic study in normal human hearts. J Thorac Cardiovasc Surg. 1999; 118(4): 636–641.
  23. She JQ, Guo JJ, Yu YF, et al. Left ventricular outflow tract obstruction in hypertrophic cardiomyopathy: the utility of myocardial strain based on cardiac MR tissue tracking. J Magn Reson Imaging. 2021; 53(1): 51–60.
  24. Standring S. Gray’s anatomy: the anatomical basis of clinical practice. 39th ed. Elsevier Churchill Livingstone, London 2005.
  25. Vendramin I, Milano AD, Pucci A, et al. Artificial chordae for mitral valve repair. J Card Surg. 2022; 37(11): 3722–3728.
  26. Walmsley R. Anatomy of left ventricular outflow tract. Br Heart J. 1979; 41(3): 263–267.
  27. Yamamoto K, Mori S, Fukuzawa K, et al. Revisiting the prevalence and diversity of localized thinning of the left ventricular apex. J Cardiovasc Electrophysiol. 2020; 31(4): 915–920.