The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 5 , Pages 1077-1081, May 2009

Mitral leaflet anatomy revisited

  • Jason L. Quill, BS

      Affiliations

    • Departments of Surgery and Biomedical Engineering, University of Minnesota, Minneapolis, Minn
    • ,
  • Alexander J. Hill, PhD

      Affiliations

    • Medtronic, Inc, Minneapolis, Minn
    • ,
  • Timothy G. Laske, PhD

      Affiliations

    • Medtronic, Inc, Minneapolis, Minn
    • ,
  • Ottavio Alfieri, MD

      Affiliations

    • San Raffaele Hospital of Milan, Milan, Italy
    • ,
  • Paul A. Iaizzo, PhD

      Affiliations

    • Departments of Surgery and Biomedical Engineering, University of Minnesota, Minneapolis, Minn
    • Corresponding Author InformationAddress for reprints: Paul A. Iaizzo, PhD, Department of Surgery, University of Minnesota, B172 Mayo, MMC 107, 420 Delaware Street SE, Minneapolis, MN 55455.

Received 15 May 2008; received in revised form 25 August 2008; accepted 8 October 2008. published online 17 February 2009.

Objective

The aims of this work were to employ functional imaging capabilities of the Visible Heart laboratory and endoscopic visualization of mitral valves in perfusion-fixed specimens to better characterize variability in mitral valve leaflet anatomy and to provide a method to classify mitral leaflets that varies from the current nomenclature.

Methods

We gathered functional endoscopic video footage (11 isolated reanimated human hearts) and static endoscopic anatomical images (38 perfusion-fixed specimens) of mitral leaflets. Commissure and cleft locations were charted using Carpentier's accepted description.

Results

All hearts had 2 commissures separating anterior and posterior leaflets. “Standard” clefts separating P1/P2 were found in 66% of hearts (n = 25), and standard clefts separating P2/P3 were present in 71% of hearts (n = 27). “Deviant” clefts occurred in each region of the anterior leaflet (A1, A2, A3), and their relative occurrences were 5%, 8%, and 13% (n = 2, 3, 5), respectively. Deviant clefts were found in posterior leaflets: 13.2% in P1 (n = 5), 32% in P2 (n = 12), and 21% in P3 (n = 8).

Conclusions

Humans elicit complex and highly variable mitral valve anatomy. We suggest a complementary, yet simple nomenclature to address variation in mitral valve anatomy by describing clefts as either standard or deviant and locating regions in which they occur (A1 to A3 or P1 to P3).

CTSNet classification: 35

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 This work was supported in part by the Institute for Engineering in Medicine at the University of Minnesota and by Medtronic, Inc.

PII: S0022-5223(08)01670-X

doi:10.1016/j.jtcvs.2008.10.008

The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 5 , Pages 1077-1081, May 2009

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