ABSTRACT
The atrioventricular valve is the most commonly repaired valve of the heart. Interventional procedures like annuloplasties, valvotomy/valvuloplasty, repair/replacement of the valve for regurgitation or prolapse are increasing by the day. This necessitates a clear understanding of the mitral valve anatomy. The present study is an attempt to revisit the anatomy of mitral valve. The present study was conducted on 34 adult embalmed heart specimens. Based on the newly defined criteria, observations were made on: 1) Number of commissures and their positions, 2) Number and position of leaflets, 3) Number and position of minor commissures, 4) Annular circumference (AC), 5) Length of annular attachment of each leaflet (LAA), 6) Maximum width of coapted/ folded margin (FM) of the anterior and posterior leaflet, 7) The surface area of each leaflet (SA). The observations were analyzed statistically. The findings of the present study and the subsequent statistical analysis offer a dynamic concept of the anatomy of mitral valve leaflets. It suggests that the valvular anatomy depends upon a complex interplay of various valve components. The extra leaflets tend to occur when annular circumference increases and is not appropriately compensated by various valvular elements. The different methodology adopted in the present study and the interpretations deduced hereupon, shall dispel the existing ambiguities in the description of the leaflets and improve our understanding of the structure and function of the mitral valve complex.
La valva atrioventricular es la valva más comúnmente reparada del corazón. Los procedimientos intervencionistas como anuloplastías, valvotomía/valvoplastía, reparación/reemplazo de la valva por la regurgitación o prolapso están aumentando día a día. Para ello, se requiere una clara comprensión de la anatomía de la valva atrioventricular. El presente estudio intenta volver a examinar la anatomía de la valva atrioventricular. Se estudiaron 34 corazones de adultos embalsamados. Sobre la base de los criterios definidos, se realizaron las siguientes observaciones: 1) número de comisuras y sus posiciones, 2) número y localización de los velos, 3) número y localización de las comisuras menores, 4) circunferencia anular (AC), 5) longitud de la unión anular de cada valva (LAA), 6) ancho máximo del margen de coaptación/margen velar (FM) de los velos anterior y posterior y 7) área de superficie de cada valva (SA). Las observaciones fueron analizadas estadísticamente. Los resultados del presente estudio y el análisis estadístico ofrecen un concepto dinámico de la anatomía de la valva atrioventricular. Se sugiere que la anatomía de las valvas depende de una interacción compleja de varios de sus componentes. Los velos adicionales tienden a aparecer cuando aumenta la circunferencia anulares y no se compensa adecuadamente por diversos elementos valvares. La diferente metodología adoptada en el presente estudio sus interpretaciones, podrían disipar ambigüedades existentes en la descripción de las valvas y mejorar nuestra comprensión de la estructura y función del complejo de la valva atrioventricular.
Subject(s)
Humans , Adult , Mitral Valve/anatomy & histology , Cadaver , India , Heart Valves/anatomy & histologyABSTRACT
Objective: To describe the normal and variant anatomy of the coronary artery ostia in Indian subjects. Introduction: Anomalous coronary origins may cause potentially dangerous symptoms, and even sudden death during strenuous activity. A cadaveric study in an unsuspected population provides a basis for understanding the normal variants, which may facilitate determination of the prevalence of anomalies and evaluation of the value of screening for such anomalies. Methods: One hundred and five heart specimens were dissected. The number of ostia and their positions within the respective sinuses were observed. Vertical and circumferential deviations of the ostia were observed. The heights of the cusps and the ostia from the bottom of the sinus were measured. Results: No openings were present in the pulmonary artery or the non-coronary sinus. The number of openings in the aortic sinuses varied from 2-5 in the present series; multiple ostia were mostly seen in the anterior sinus. The majority of the ostia lay below the sinutubular ridge (89 percent) and at or above the level of the upper margin of the cusps (84 percent). Left ostial openings were mainly centrally located (80 percent), whereas the right coronary ostia were often shifted towards the right posterior aortic sinus (59 percent). Discussion: The preferential location of the ostia was within the sinus and above the cusps, but below the sinutubular ridge. On occasion, normal variants like multiple ostia, vertical or circumferential shift in the position, and slit-like ostia may create confusion in interpreting the images and pose a difficulty during procedures like angiography, angioplasty, and coronary artery bypass grafting.