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The Mitral Valve: Anatomy and Pathology for the Surgeon

The Mitral Valve: Anatomy and Pathology for the Surgeon Abstract Anatomy The mitral valve in the normal adult consists of 2 tough, membranous, elastic, extremely thin and pliable leaflets anchored at their bases to the annulus. Numerous slender tendinous chords are attached at the margins of their ventricular surfaces. The chords arise from 2 muscular masses on the anterior and posterior walls of the ventricular myocardium. Figure 2 illustrates the anatomy of the mitral valve derived from a sphere.In Figure 2A, a shell which is slightly less than a hemisphere has an irregularly shaped portion removed from it, creating 2 flaps which when everted resemble the leaflets of the mitral valve (Fig. 2B). Motion of the flaps away from the center of the original sphere illustrates the valve opening (Fig. 2C); motion of the flaps towards the center demonstrates valve closure (Fig. 2D). The larger, tongue-like, flap is variously known as the anteromedial, septal, major, References 1. Glover, R. P., and Davila, J. C.: The Surgery of Mitral Stenosis , New York, Grune & Stratton, Inc., 1961. 2. Gross, L., and Kugel, M. A.: Topographic Anatomy and Histology of the Valves in the Human Heart , Amer. J. Path. 7:445-473, 1931. 3. Magarey, F. R.: On the Mode of Formation of Lambl's Excrescences and Their Relation to Chronic Thickening of the Mitral Valve , J. Path. Bact. 61:203-208, 1949.Crossref 4. Harken, D. E.; Ellis, L. B.; Dexter, L.; Farrand, R. E., and Dickson, J. F.: The Responsibility of the Physician in the Selection of Patients for the Surgical Treatment of Mitral Stenosis , Circulation 5:349-362, 1952.Crossref 5. Rusted, I. E.; Schiefley, C. H., and Edwards, J. E.: Studies of the Mitral Valve: I. Anatomic Features of the Normal Mitral Valve and Associated Structures , Circulation 6:825-831, 1952.Crossref 6. Davila, J. C.; Mattson, W. M.; O'Neill, T. J. E., and Glover, R. P.: Method for the Surgical Correction of Mitral Insufficiency , Surg. Gynec. Obstet. 98:407-412, 1954. 7. Brock, R. C.: The Surgical and Pathological Anatomy of the Mitral Valve , Brit. Heart J. 14: 489-513, 1952.Crossref 8. Rauber, A.: Lehrbuch der Anatomie des Menschen , Ed. 4, Leipzig, Eduard Besold, 1893, Vol. 2, p. 50. 9. Rusted, I. E.; Schiefley, C. H.; Edwards, J. E., and Kirklin, J. W.: Guides to the Commissures in Operations Upon the Mitral Valve , Proc. Mayo Clin. 26:297-305, 1951. 10. Davila, J. C.: The Mechanics of Cardiac Valves (read at the Work Conference on Artificial Valves for Cardiac Surgery, Fall, 1960, at Edgewater Beach Hotel, Chicago), Springfield, Ill., Charles C Thomas, Publisher, 1961. 11. Edwards, J. E.: Personal communication to the authors, January, 1959. 12. Edwards, J. E., and Burchell, H. B.: Pathologic Anatomy of Mitral Insufficiency , Proc. Mayo Clin. 33:497-509, 1958. 13. Magarey, F. R.: Pathogenesis of Mitral Stenosis , Brit. Med. J. 1:856-857, 1951.Crossref 14. Clawson, B. J.: Rheumatic Heart Disease: An Analysis of 796 Cases , Amer. Heart J. 20: 454-474, 1940.Crossref 15. Davila, J. C.; Kyle, R. H., and Glover, R. P.: Mitral Regurgitation Due to Ruptured Chordae Tendineae: Correction by "Mitral Purse-String," Amer. Heart J. 54:940-946, 1957.Crossref 16. Bailey, C. P., and Hirose, T.: Maximal Reconstitution of Stenotic Mitral Valve by Neostrophingic Mobilization (Rehinging of the Septal Leaflet) , J. Thor. Surg. 35:559-583, 1958. 17. Glover, R. P., and Davila, J. C.: The Treatment of Mitral Insufficiency by the Purse-String Technique , J. Thor. Surg. 33:75-101, 1957. 18. Edwards, J. E., and Burchell, H. B.: The Pathological Anatomy of Deficiencies Between the Aortic Root and the Heart, Including Aortic Sinus Aneurisms , Thorax 12:125-139, 1957.Crossref 19. Davila, J. C.; Trout, R. G.; Sunner, J. E., and Glover, R. P.: A Simple Mechanical Pulse Duplicator for Cinematography of Cardiac Valves in Action , Ann. Surg. 143:544-551, 1956.Crossref 20. Stirling, G. R.: The Surgical Anatomy of the Heart , Alfred Hosp. Clin. Rep. 8:93-108, 1958. 21. Van der Spuy, J. C.: The Functional and Clinical Anatomy of the Mitral Valve , Brit. Heart J. 20:471-478, 1958.Crossref 22. Walmsley, R.: The Orientation of the Heart and the Appearance of Its Chambers in the Adult Cadaver , Brit. Heart J. 20:441-458, 1958.Crossref 23. Chiechi, M. A.; Lees, W. M., and Thompson, R.: Functional Anatomy of the Normal Mitral Valve , J. Thor. Surg. 32:378-398, 1956. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

The Mitral Valve: Anatomy and Pathology for the Surgeon

Archives of Surgery , Volume 84 (2) – Feb 1, 1962

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References (23)

Publisher
American Medical Association
Copyright
Copyright © 1962 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1962.01300200022003
Publisher site
See Article on Publisher Site

Abstract

Abstract Anatomy The mitral valve in the normal adult consists of 2 tough, membranous, elastic, extremely thin and pliable leaflets anchored at their bases to the annulus. Numerous slender tendinous chords are attached at the margins of their ventricular surfaces. The chords arise from 2 muscular masses on the anterior and posterior walls of the ventricular myocardium. Figure 2 illustrates the anatomy of the mitral valve derived from a sphere.In Figure 2A, a shell which is slightly less than a hemisphere has an irregularly shaped portion removed from it, creating 2 flaps which when everted resemble the leaflets of the mitral valve (Fig. 2B). Motion of the flaps away from the center of the original sphere illustrates the valve opening (Fig. 2C); motion of the flaps towards the center demonstrates valve closure (Fig. 2D). The larger, tongue-like, flap is variously known as the anteromedial, septal, major, References 1. Glover, R. P., and Davila, J. C.: The Surgery of Mitral Stenosis , New York, Grune & Stratton, Inc., 1961. 2. Gross, L., and Kugel, M. A.: Topographic Anatomy and Histology of the Valves in the Human Heart , Amer. J. Path. 7:445-473, 1931. 3. Magarey, F. R.: On the Mode of Formation of Lambl's Excrescences and Their Relation to Chronic Thickening of the Mitral Valve , J. Path. Bact. 61:203-208, 1949.Crossref 4. Harken, D. E.; Ellis, L. B.; Dexter, L.; Farrand, R. E., and Dickson, J. F.: The Responsibility of the Physician in the Selection of Patients for the Surgical Treatment of Mitral Stenosis , Circulation 5:349-362, 1952.Crossref 5. Rusted, I. E.; Schiefley, C. H., and Edwards, J. E.: Studies of the Mitral Valve: I. Anatomic Features of the Normal Mitral Valve and Associated Structures , Circulation 6:825-831, 1952.Crossref 6. Davila, J. C.; Mattson, W. M.; O'Neill, T. J. E., and Glover, R. P.: Method for the Surgical Correction of Mitral Insufficiency , Surg. Gynec. Obstet. 98:407-412, 1954. 7. Brock, R. C.: The Surgical and Pathological Anatomy of the Mitral Valve , Brit. Heart J. 14: 489-513, 1952.Crossref 8. Rauber, A.: Lehrbuch der Anatomie des Menschen , Ed. 4, Leipzig, Eduard Besold, 1893, Vol. 2, p. 50. 9. Rusted, I. E.; Schiefley, C. H.; Edwards, J. E., and Kirklin, J. W.: Guides to the Commissures in Operations Upon the Mitral Valve , Proc. Mayo Clin. 26:297-305, 1951. 10. Davila, J. C.: The Mechanics of Cardiac Valves (read at the Work Conference on Artificial Valves for Cardiac Surgery, Fall, 1960, at Edgewater Beach Hotel, Chicago), Springfield, Ill., Charles C Thomas, Publisher, 1961. 11. Edwards, J. E.: Personal communication to the authors, January, 1959. 12. Edwards, J. E., and Burchell, H. B.: Pathologic Anatomy of Mitral Insufficiency , Proc. Mayo Clin. 33:497-509, 1958. 13. Magarey, F. R.: Pathogenesis of Mitral Stenosis , Brit. Med. J. 1:856-857, 1951.Crossref 14. Clawson, B. J.: Rheumatic Heart Disease: An Analysis of 796 Cases , Amer. Heart J. 20: 454-474, 1940.Crossref 15. Davila, J. C.; Kyle, R. H., and Glover, R. P.: Mitral Regurgitation Due to Ruptured Chordae Tendineae: Correction by "Mitral Purse-String," Amer. Heart J. 54:940-946, 1957.Crossref 16. Bailey, C. P., and Hirose, T.: Maximal Reconstitution of Stenotic Mitral Valve by Neostrophingic Mobilization (Rehinging of the Septal Leaflet) , J. Thor. Surg. 35:559-583, 1958. 17. Glover, R. P., and Davila, J. C.: The Treatment of Mitral Insufficiency by the Purse-String Technique , J. Thor. Surg. 33:75-101, 1957. 18. Edwards, J. E., and Burchell, H. B.: The Pathological Anatomy of Deficiencies Between the Aortic Root and the Heart, Including Aortic Sinus Aneurisms , Thorax 12:125-139, 1957.Crossref 19. Davila, J. C.; Trout, R. G.; Sunner, J. E., and Glover, R. P.: A Simple Mechanical Pulse Duplicator for Cinematography of Cardiac Valves in Action , Ann. Surg. 143:544-551, 1956.Crossref 20. Stirling, G. R.: The Surgical Anatomy of the Heart , Alfred Hosp. Clin. Rep. 8:93-108, 1958. 21. Van der Spuy, J. C.: The Functional and Clinical Anatomy of the Mitral Valve , Brit. Heart J. 20:471-478, 1958.Crossref 22. Walmsley, R.: The Orientation of the Heart and the Appearance of Its Chambers in the Adult Cadaver , Brit. Heart J. 20:441-458, 1958.Crossref 23. Chiechi, M. A.; Lees, W. M., and Thompson, R.: Functional Anatomy of the Normal Mitral Valve , J. Thor. Surg. 32:378-398, 1956.

Journal

Archives of SurgeryAmerican Medical Association

Published: Feb 1, 1962

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