ABSTRACT
BACKGROUND AND AIMS OF THE STUDY: Mitral homograft replacement requires a good knowledge of the anatomy of the papillary muscles. Clinical experience with mitral homografts has revealed an as yet unexplored aspect of the morphology of the mitral subvalvular apparatus, that is correspondence between papillary muscle sub-divisions and chordal attachment to the leaflets. METHODS: To further our understanding we subjected 65 normal hearts to close scrutiny which confirmed our perioperative observations. RESULTS: We could establish a classification based on the ways that the papillary muscles relate to the leaflets via the chordae. Four types are described. In type I the papillary muscle is single. In type II the papillary muscle has two heads, one of which sends chordae exclusively to the posterior leaflet. In type III the papillary muscle is also divided, one head supporting the commissural area exclusively. Type IV PM resembles type III but is distinguished from it in the way that the head supporting the commissure is very short. In this type the different heads also originate at different levels on the ventricular wall from the apex to the base.
Subject(s)
Mitral Valve/anatomy & histology , Muscle Fibers, Skeletal/classification , Papillary Muscles/anatomy & histology , HumansABSTRACT
The authors report a case of an iatrogenic fistula between the left circumflex coronary artery and left atrium. The fistula was a complication of reoperation to replace a mitral valvuloplasty annulus by a mechanical hemi-disc prosthesis (Saint Jude Medical). Diagnosis was made by transoesophageal echocardiography and confirmed by coronary angiography. The patient underwent external ligature under cardio-pulmonary bypass.
