scholarly journals Anatomical consideration of the number and form of the papillary muscle in the left ventricle

2016 ◽  
Vol 22 (2) ◽  
pp. 119-127 ◽  
Author(s):  
Ruxandra Gheorghitescu ◽  
M. Toba ◽  
D.M. Iliescu ◽  
P. Bordei
Keyword(s):  
Left Ventricle ◽  
Upper Extremity ◽  
Papillary Muscle ◽  
Lower Half ◽  
Papillary Muscles ◽  
Maximum Width ◽  
Posterior Papillary Muscle ◽  
Anterior Papillary Muscle

Abstract Our results were obtained by dissection of 56 cords, wich presented at the papillary muscle of the left ventricle, 106 muscular bodies and from those, 58 muscular bodies were for the anterior papillary muscle and 48 for the posterior papillary muscle. Anterior papillary muscle was studied on 32 cords, and the posterior papllary muscle on 24 cases. Of the 106 papillary muscles we analized, unique papillary muscle was incountered in 16 cases, 10 being at the anterior papillary muscle and 6 cases at the posterior papillary muscle.. The papillary muscle formed of two muscular bodies (double) presented a number of 64 muscular bodies, 36 being at the anterior papillary and 28 at the posterior papillary. In cases of triple papillary muscle, from 18 muscular bodies, 12 were from the anterior papillary and 6 were from posterior papillary. In the two cases of quadruple papillary muscle the 8 muscular bodies belonged to the posterior papillary muscle. Amoung the total muscular bodies, most frequently they had a conical hape, aspect found in 67 cases, 33 cases being seen in the anterior papillary muscle and 34 in the posterior papillary. In 20 cases the muscular bodies were cylindrical, 18 cases were found in the anterior papillary and 2 in the posterior papillary muscle. In 10 cases the muscular bodies were arcuated, 4 cases being to anterior papillary and 6 cases to the posterior papillary muscle. In 8 cases the bodies were fusiform, 4 cases being to the anterior papillary and 4 to the posterior papillary muscle. In one case to an unique posterior papillary muscle we found a particullar form of the muscular body, wich we called „the torch“ or the „beacon“ that have the muscular body thinner at the lower half and the size increasing in width, reaching a maximum width at its upper extremity, from where are detaching four extra muscles that gave birth to beams of valvular chordage. In case of papillary muscles with two muscular bodies, they can sometimes be linked by a muscular bridge, transverse or oblique, making characteristical features. Thus, in 6 cases, the muscular bridges realized the H“ letter appearance, 4 cases being at the anterior papillary muscle and 2 at the posterior papillary. In 4 cases only at the anterior papillary the bridges formed „N“ letter aspect, 2 cases were at the anterior papilllary and 2 in the posterior papillary muscle. Also in 4 cases, the presence of the bridges acheve the appearance of reversed „N“ letter, 2 cases were in the anterior papillary and 2 in the postertior papillary.

scholarly journals Morphological features of papillary muscles in the right ventricle

2016 ◽  
Vol 22 (3) ◽  
pp. 135-144
Author(s):  
(Janca) Ruxandra Gheorghitescu ◽  
M. Toba ◽  
D.M. Iliescu ◽  
P. Bordei
Keyword(s):  
Right Ventricle ◽  
Papillary Muscle ◽  
Single Case ◽  
Morphological Characteristics ◽  
Cylindrical Shape ◽  
Papillary Muscles ◽  
Conical Shape ◽  
Posterior Papillary Muscle ◽  
The Right ◽  
Anterior Papillary Muscle

Abstract Our study was performed by dissecting formalinized cord, aiming at:the number of bodies of each papillary muscle in the right ventricle, the shape of the muscular body, also the morphological characteristics of the tendon chordaes. The anterior papillary muscles of the right ventricle, were studied on 54 cords, finding a total of 82 papillary muscles. Unique anterior papillary was found in 59.26% of case, representing 38.10% of total anterior papillary muscles. In 29.63% of cases, the anterior papillary muscle was double and in 11.11% of cases was threefold. The conical shape we found in 57.32% of the anterior papillary muscles, and the cylindrical shape encountered in 29.27% of cases. In case of double papilaery muscles, sometimes beeing joined at various levels between them, they realized particular aspects in each 2.44 % of cases, presenting the „N” and „H” letter appearance and in 1.22% of cases one of the two papilary presented an arcuate shape. At the unique papillary in one case (1.22%) we have found pyramidal forms and reversed „V” letter. The valvular tendinous chordae of the anterior papillaries, we have pursued on a number of 78 papillary muscles and we found that most frequently they broke loose from the superior side, in 41.03% of cases detaching from the tip of conical unique papillaries romthe superior si of those cylindrical. The posterior papillar muscles of the rght ventricle we studied on 42 cords, presenting 69 papillary muscles. Single posterior papillary muscle we found in 52.38% of cases, in 33.33% of cases was double, triple in 11.90% of cases and in one case (2.38%) the posterior papillry was quadruple. Most commonly, the posterior papillary muscle presents a conical shape, aspect found in 65.22% of cases, in 27.54% of cases was cylindric, in 2.90% of cases we found a papillary muscle in reversed „Y” shape (at double papillary), and in one single case (1.54%) we found one arcuated papillary (in one double paillary), one irregular papillary (at unique papillaries) and one papillary in reversed „N” letter (between two muscular bodies of one triple papillary). Valvular chordaes of the posterior papillary muscles, most frequently broke loose from the tip or superior edge of the papillary, aspect found in 35.48% of cases. Septal papillary muscles that we studied on 43 cords, were represented either by a number of 3-5 beams, or 5-9 simpe chordae tendons, both tipes could present or not at their origin on the septomarginal strip, a muscular cone. Rarely can present 1-3 large muscular cones that sometimes can be considered true papillary muscles. We found the arterial muscle cone, present in all cases, beeing represented by chordae bundles arising from a muscular cone and rarely not showing muscular cone at his origin or can be represented by two beams of valvular chordae. We encountered one case where septal papillaries were represented by 3 conical muscular bodies, well represented, comparable in size with the anterior and posterior papillary muscles, especially the superior and inferior muscular bodies, the middle beeing shorter. We found in 13.95% of cases the existence of the posterior’s angle papillary muscle of the right ventricle, conical and cylindrical papillary muscle, that sent tendon chordae only to the septal leaflet.

scholarly journals Comparative Study Between the Papillary Muscles of the Right Ventricle and the Left Ventricle Papillary Muscles

2018 ◽  
Vol 24 (2) ◽  
pp. 77-81
Author(s):  
Tobă Marius ◽  
Iliescu Dan Marcel ◽  
Bordei Petru ◽  
Popescu-Chiriloaie Cristina ◽  
Gheorghiţescu Jancă Ruxandra
Keyword(s):  
Left Ventricle ◽  
Right Ventricle ◽  
Comparative Study ◽  
Upper Extremity ◽  
Papillary Muscle ◽  
Muscle Group ◽  
Ventricular Wall ◽  
Papillary Muscles ◽  
Chordae Tendineae ◽  
The Right

Abstract We used formalinized heart dissection obtained from forensic laboratory in Constanta, analyzing the papillary muscles and their tendon chordae. We studied at the papillary muscles the number of forms that could be in single or multiple muscular bodies, encountering more than five body muscles in a papillary muscle group. We measured using caliper graduated in millimeters, the height of each papillary muscle body (from the base to its upper end) and its thickness at the base and at its upper extremity. Chordae tendon we examined in terms of their origin and number at the level of each papillary muscle, the dimensions (length and thickness), orientation and how they end at the atrioventricular valves. We noted the presence of „false”chordae tendineae, which were disposed between the papillary muscle and the ventricular wall. The results were compared with data in the literature that I had the opportunity to consult

Inter-Basal and Septal Connections of Papillary Muscles - An Anatomical Rationale for Rhythmic Opening of AV Valves - A Multicentric Medical College Based Cross Sectional Study

2021 ◽  
Vol 8 (31) ◽  
pp. 2865-2869
Author(s):  
Praveen Mulki Shenoy ◽  
Amith Ramos ◽  
Narasimha Pai ◽  
Bharath Shetty ◽  
Aravind Pallipady Rao
Keyword(s):  
Left Ventricle ◽  
Papillary Muscle ◽  
Interventricular Septum ◽  
Cross Sectional Study ◽  
Papillary Muscles ◽  
Cross Sectional ◽  
Medical College ◽  
Moderator Band ◽  
Almost All ◽  
And Function

BACKGROUND The papillary muscle basal connections have significant clinical implications. Variety of studies done on its morphology and function by various specialists in different departments. A close look on these revealed the interconnections of papillary muscles to one another and to the interventricular septum of both ventricles is related to uncoordinated contractions of papillary muscles, leading to hyper or hypokinesia or prolapse or even its rupture. METHODS Our study done in 25 formalin soaked hearts revealed after the deep and meticulous dissection, reflecting the walls of ventricles laterally the numerous interconnections of papillary muscles at its bases and IVS. Ventricles are opened by inverted ‘L’ shaped incision and its reflected more laterally till all the papillary muscles is visible in one frame after incising the moderator band. The connections were noted, measured, photographed, tabulated, compared with similar studies and analysed with experts with respective fields. RESULTS Almost all the specimens did have the interconnections. Further the post mortem findings of the cardiac related deaths with involvement of papillary muscles suggest damage to such ‘bridges’. The moderator band extensions to the base of right APM, and its extension to the posterior groups is noted in all the specimens. The bridge from the IVS to bases of both the groups of papillary muscles is noted in left ventricle. In90% of specimens the one PPM is found to be loosely connected, more so in left ventricle. CONCLUSIONS We are of a conclusion that such basal interconnections and to the interventricular septum are responsible for rhythmic contractions of papillary muscles of both ventricles. Since the AV valves have to open simultaneously, interconnections becomes mandatory as the impulse has to reach it before it reaches the trabeculae carniae. One of the Posterior papillary muscles is loosely connected to other papillary muscles, may be the reason for its rupture, more so in left ventricle. KEYWORDS Papillary Muscle, Interbasal Connection, Moderator Band, Valvular Prolapse, AV Valves

scholarly journals Cryoablation for Ventricular Tachycardia Originating from Anterior Papillary Muscle of Left Ventricle Guided by Intracardiac Echocardiography

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Ibrahim Marai ◽  
Nizar Andria ◽  
Osnat Gurevitz
Keyword(s):  
Ventricular Tachycardia ◽  
Left Ventricle ◽  
Intracardiac Echocardiography ◽  
Papillary Muscles ◽  
Rf Ablation ◽  
Image Integration ◽  
3 Dimensional ◽  
Mapping System ◽  
Anterior Papillary Muscle ◽  
Dimensional Mapping

Papillary muscles (PMs) were reported to be origin of ventricular arrhythmia (VA). Radiofrequency (RF) ablation was reported to be acutely effective in eliminating VA. However, the recurrence rate is high. Recently, cryoablation guided by intracardiac echocardiography, 3-dimensional mapping system, and image integration was introduced as alternative strategy for this challenging ablation. We present a case of ventricular tachycardia originating from anterior PM of left ventricle treated by cryoablation guided only by intracardiac echocardiography.

Abstract 2304: Impact of Papillary Muscle Relocation as Adjunct Procedure to Mitral Ring Annuloplasty in Functional Ischemic Mitral Regurgitation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Henrik Jensen ◽  
Morten O Jensen ◽  
Morten H Smerup ◽  
Stefan Vind-Kezunovic ◽  
Steffen Ringgaard ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Ischemic Mitral Regurgitation ◽  
Papillary Muscles ◽  
Posterior Papillary Muscle ◽  
Ring Annuloplasty ◽  
Group A ◽  
Leaflet Coaptation ◽  
The Impact ◽  
3D Magnetic Resonance Imaging

The optimal surgical treatment in functional ischemic mitral regurgitation (FIMR) remains controversial. Recently, a posterior papillary muscle relocation (PMR) technique as adjunct procedure to ring annuloplasty has been proposed to prevent recurrent FIMR. We assessed the hypothesis that relocating both papillary muscles as adjunct procedure to down-sized ring annuloplasty improves mitral leaflet coaptation geometry in FIMR pigs. Eleven FIMR pigs were randomized to down-sized ring annuloplasty (RA, N=6) or RA combined with PMR (RA+PMR, N=5). In the RA+PMR group a 2– 0 Goretex suture was attached to each trigone, exteriorized through the corresponding papillary muscle, mounted on an epicardial pad and tightened to relocate the myocardium adjacent to the anterior and posterior papillary muscles 5 and 15 mm, respectively. Using 3D magnetic resonance imaging the impact from these interventions on leaflet geometry was assessed. Statistically significant (p<0.05) differences in postoperative leaflet geometry were observed at end-systole (RA vs. RA+PMR, mean ±SEM): Occlusional leaflet area (877 ±36 vs. 666 ±52 mm 2 ), tenting volume (1620 ±132 vs. 1064 ±198 mm 3 ), mean tenting height (5.9 ±0.2 vs. 4.9 ±0.3 mm), mean coaptation length (6.5 ±0.2 vs. 7.6 ±0.3 mm). Figure 1 shows coaptation length and tenting height of leaflet segments A1-P1, A2-P2 and A3-P3 at end-systole. Adding papillary muscle relocation to down-sized ring annuloplasty reduced leaflet tethering and improved coaptation geometry and therefore holds promise for reducing the prevalence of recurrent FIMR in patients.

Morphological three-dimensional analysis of papillary muscles in borderline left ventricles

2017 ◽  
Vol 27 (7) ◽  
pp. 1369-1376
Author(s):  
Mari N. Velasco Forte ◽  
Mohamed Nassar ◽  
Nick Byrne ◽  
Miguel Silva Vieira ◽  
Israel V. Pérez ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Ventricle ◽  
Papillary Muscle ◽  
Three Dimensional ◽  
Papillary Muscles ◽  
Biventricular Repair ◽  
Muscle Morphology ◽  
Significant Difference ◽  
Surgical Options

AbstractObjectiveMitral valve anatomy has a significant impact on potential surgical options for patients with hypoplastic or borderline left ventricle. Papillary muscle morphology is a major component regarding this aspect. The purpose of this study was to use cardiac magnetic resonance to describe the differences in papillary muscle anatomy between normal, borderline, and hypoplastic left ventricles.MethodsWe carried out a retrospective, observational cardiac magnetic resonance study of children (median age 5.36 years) with normal (n=30), borderline (n=22), or hypoplastic (n=13) left ventricles. Borderline and hypoplastic cases had undergone an initial hybrid procedure. Morphological features of the papillary muscles, location, and arrangement were analysed and compared across groups.ResultsAll normal ventricles had two papillary muscles with narrow pedicles; however, 18% of borderline and 46% of hypoplastic cases had a single papillary muscle, usually the inferomedial type. In addition, in borderline or hypoplastic ventricles, the supporting pedicle occasionally displayed a wide insertion along the ventricular wall. The length ratio of the superolateral support was significantly different between groups (normal: 0.46±0.08; borderline: 0.39±0.07; hypoplastic: 0.36±0.1; p=0.009). No significant difference, however, was found when analysing the inferomedial type (0.42±0.09; 0.38±0.07; 0.39±0.22, p=0.39). The angle subtended between supports was also similar among groups (113°±17°; 111°±51° and 114°±57°; p=0.99). A total of eight children with borderline left ventricle underwent biventricular repair. There were no significant differentiating features for papillary muscle morphology in this subgroup.ConclusionsThe superolateral support can be shorter or absent in borderline or hypoplastic left ventricle cases. The papillary muscle pedicles in these patients often show a broad insertion. These changes have important implications on surgical options and should be described routinely.

scholarly journals P1720 Hammock mitral valve, a challenging echocardiographic diagnosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Rodrigo Carbonero ◽  
U Estandia ◽  
C Perez ◽  
R Voces ◽  
P Perez ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Papillary Muscle ◽  
Tricuspid Regurgitation ◽  
Pulmonary Veins ◽  
Left Ventricular ◽  
Valve Disease ◽  
Valve Prosthesis ◽  
Papillary Muscles ◽  
Rheumatic Valve Disease

Abstract We report a 43 year-old female with a past TTE echocardiography of rheumatic valve disease performed in her district hospital , ( No clear symptomatology of rheumatic fever in the past). She was transferred to our tertiary hospital for elective cardiac surgery. Preoperative echocardiogram showed a non-dilated left ventricle with preserved contractility, mild-moderate left atrium enlargement with severe mitral regurgitation and basal displacement of papillary muscles and severe tricuspid regurgitation.All of it resembling a hammock mitral valve instead of former echocardiogram described as rheumatic valve disease. Preoperative cardiac study showed severe pulmonary hypertension with increased pulmonary vascular resistances. Preserved biventricular cardiac output and increased proto and telesystolic pressures. During surgery , ifindings were described as a mitral valve with a large papillary muscle inserted in the distal third of the left ventricle with none tendinous cords at the anterior leaflet and without cords in the posterior leaflet with an isolated papillary muscle with cords at A3 and P3 scallops, compatible with hammock mitral valve. A tendinous muscle/fibrous or fibromuscular band connecting the septum to the posterior wall of the left ventricle was described. Moreover over, there was an enlarged tricuspid ring with very short tendinous cords on the septal leaflet, although the leaflet was bigger than usual. Surgery consisted of resection of the mitral valve preserving A3 and P3 scallops with a 29mm Bicarbon Sorin mechanical mitral prosthesis and a 32mm Carpentier tricuspid ring implantation and pulmonary veins ablation combined with occlusion of left atrial appendage. After 112 minutes of cross-clamping time, the patient was weaned from cardiopulmonary bypass. She had important left ventricle dysfunction which improved with dobutamine and AAI pacemaker at 90lpm. Postoperative TEE showed moderate dysfunction of right ventricle, mild left ventricular dysfunction, moderate tricuspid regurgitation and a good functioning of the prosthesis. TTE before discharge showed good function of mitral valve prosthesis, good left ventricle function, mild tricuspid regurgitation, mild-moderate right ventricular enlargement, although less than preoperatively. Conclusion Congenital mitral valulophaty is a rare condition in the adulthood. The estimated prevalence is 0,5%. The hammock mitral valve is a more uncommon pathology which affects the mitral valve and subvalvular apparatus. This anomaly, was first described in 1967 and it is characterised by anomalous papillary muscles directly connected to the anterior mitral valve by a fibrous bridge without chordae tendineae in between them. This fibrous bridge hampers the opening and closure of the mitral valve. Diagnosis requires a high index of suspicion, both ultrasound studies and medical history, to avoid misdiagnosis. Abstract P1720 Figure.

scholarly journals Intramural Coronary Arteriosclerosis of Normal and Dwarfed Swine

1976 ◽  
Vol 13 (2) ◽  
pp. 104-109 ◽  
Author(s):  
K. L. Kammermann ◽  
H. Luginbühl ◽  
H. L. Ratcliffe
Keyword(s):  
Growth Rate ◽  
Psychosocial Factors ◽  
Papillary Muscle ◽  
Coronary Arteriosclerosis ◽  
Posterior Papillary Muscle ◽  
Left Posterior ◽  
Anterior Papillary Muscle ◽  
Large Groups

Dwarfing of swine maintained in large groups with relatively little space per animal may be attributed to psychosocial factors. Intramural coronary arteriosclerosis developed at approximately the same rate in dwarfed and normally developing animals. Lesions in arteries of the left posterior papillary muscle were more advanced than in the left anterior papillary muscle of the same animal, irrespective of its growth rate, and often were more advanced than in swine twice as old.

scholarly journals Relationship between papillary muscles abnormalities and apparently unexplained infero-lateral T-wave inversion in athletes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Bettella ◽  
M De Lazzari ◽  
A Zorzi ◽  
T Vessella ◽  
A Cipriani ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Papillary Muscle ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Control Group ◽  
Papillary Muscles ◽  
Age And Gender ◽  
Significant Difference ◽  
And Gender ◽  
Apical Displacement

Abstract Aims To evaluate by cardiac magnetic resonance (CMR) if left ventricle papillary muscle abnormalities, such as hypertrophy and abnormal location, may be the anatomo-functional substrates responsible for TWI inversion in lateral or infero-lateral leads in otherwise healthy athletes. Methods We included competitive athletes with TWI in lateral or infero-lateral leads in the absence of cardiac diseases detected by CMR. The control population included healthy athletes with normal ECG, matched for age and gender. We compared thickness, volume (both absolute and relative to the cardiac mass) and position of the papillary muscles between cases and controls. Results We included 53 athletes with apparently unexplained TWI in the lateral or infero-lateral leads (median age 20 years (17–42), 86.8% males) and 53 athletes with no TWI matched for age and gender. 4 patients (7.6%) had family history for cardiomyopathy or sudden cardiac death. Athletes with TWI showed more hypertrophic papillary muscles compared to controls, with statistically significant difference in diameter, area and volume (p&lt;0.01). The median ratio between the papillary muscles and the left ventricular mass was 4.4% among athletes with TWI versus 3% among those without TWI (p&lt;0.001). Papillary muscles showed apical displacement in 47% of cases, compared to 17% in the control group (p=0.001). Conclusions Idiopathic TWI in lateral or infero-lateral leads is associated with left ventricle papillary muscle hypertrophy and their apical displacement detected by CMR. The comprehension of clinical and prognostic significance of papillary muscle abnormalities responsible for these ventricular repolarization alterations requires further studies. Example Funding Acknowledgement Type of funding source: None

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