Double- Chambered Left Ventricle and Abnormal Papillary Muscle Formation

2018 ◽  
Vol 3 (4) ◽  
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Papillary Muscle ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Ventricular Wall ◽  
Papillary Muscles ◽  
Rare Form ◽  
Mitral Valve Leaflet ◽  
Muscle Formation

Papillary muscles develop separately from mitral valve leaflet and chordae, they origin from myocardial ridge of the anterior wall and to the posterior wall of the left ventricle (LV). While chordae and mitral valve leaflets origin from a cushion tissue. The myocardial ridge gradually loosens from the ventricular wall and meanwhile the cushion tissue transforms into leaflet and chordae1. Abnormal papillary muscle formation may present a muscle bridge and divide the LV into two chambers. The most rare form is the superior inferior LV subdivision which our cases represent.

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 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

Biomechanics of the Mitral Valve in Ischemic Heart Disease: Translating From the Bench to the Operating Room

2010 ◽  
Author(s):  
Muralidhar Padala ◽  
Ajit P. Yoganathan
Keyword(s):  
Blood Flow ◽  
Mitral Valve ◽  
Left Ventricle ◽  
Left Atrium ◽  
Mitral Annulus ◽  
Normal Function ◽  
Force Balance ◽  
Papillary Muscles ◽  
Atrioventricular Valve ◽  
Main Components

The Mitral Valve (MV) is the left atrioventricular valve that controls blood flow between the left atrium and the left ventricle (Fig 1A-B). It has four main components: (i) the mitral annulus — a fibromuscular ring at the base of the left atrium and the ventricle; (ii) two collagenous planar leaflets — anterior and posterior; (iii) web of chordae and (iv) two papillary muscles (PM) that are part of the left ventricle (LV). Normal function of the mitral valve involves a delicate force balance between different components of the valve.

On the Interaction of Natural and Mechanical Heart Valve Leaflets With the Chordae Tendineae

2002 ◽  
Author(s):  
Amber R. Mace ◽  
Pavlos P. Vlachos ◽  
Demetri P. Telionis
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Mechanical Heart Valve ◽  
Postoperative Mortality ◽  
Decisive Role ◽  
Flow Dynamics ◽  
Papillary Muscles ◽  
Posterior Leaflet ◽  
Chordae Tendineae ◽  
Atrioventricular Ring

Long before mitral valve replacement (MVR) became a routine operation, physiologic studies indicated that the continuity of mitral leaflets with papillary muscles, chordae tendineae (CT) and the atrioventricular ring may play a decisive role in the function of the left ventricle (LV) [1]. This led Lillehei et al. [2] to establish a procedure whereby the posterior leaflet, its CT and papillary muscles were preserved in MVRs. These and other studies indicated a significant reduction of postoperative mortality compared to conventional MVR. Though developed in the early 1960s by Lillehei, the technique of chordal preservation was not initially accepted. It wasn’t until 1983 that surgeons began to revive the concept of MVR with preservation of the CT. As this technique became more widely known, many clinical studies were performed; however, very few have been conducted which examine the effect of leaflets and CT on flow dynamics.

Differences in distensibility between the anterior and posterior walls of the left ventricle in dogs

1991 ◽  
Vol 69 (3) ◽  
pp. 334-340
Author(s):  
Zhao-Nian Zhou ◽  
Sheng-Jing Dong ◽  
Eldon R. Smith ◽  
John V. Tyberg
Keyword(s):  
Left Ventricle ◽  
Length Change ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Left Ventricular ◽  
Transmural Pressure ◽  
Segment Length ◽  
Anesthetized Dogs ◽  
Pericardial Pressure ◽  
The Difference

Nonuniformity of myocardial systolic and diastolic performance in the normal left ventricle has been recognized by a number of investigators. Lack of homogeneity in diastolic properties might be caused by or related to differences in the distensibility of different regions of the left ventricular (LV) wall. Thus, we compared the end-diastolic transmural pressure–strain relations in both the anterior and posterior LV walls in seven anesthetized dogs during two interventions (pulmonary artery constriction and aortic constriction). Transmural pressure was defined as the difference between LV intracavitary pressure and local pericardial pressure. LV pressure was measured using a micromanometer; pericardial pressures over the LV anterior and posterior wails were measured with balloon transducers. Circumferentially oriented pairs of sonomicrometer crystals were implanted in the midwall of the anterior and posterior walls of the LV to measure segment lengths. Strains were calculated as (L – L0)/L0, where L was the instantaneous segment length and L0 was the segment length when transmural pressure was zero. The pattern of end-diastolic transmural pressure–strain relations was similar in ail dogs. The change in strain in the posterior wall was always greater than that in the anterior wall. Opening the pericardium did not affect the difference in distensibility of the anterior and posterior walls. The results suggest that the posterior wall is more compliant than the anterior wall (that is, for a given difference in transmural pressure, the local segment length change of the posterior wall was greater). This seems consistent with other observations, which suggest that the posterior wall might make a greater contribution to diastolic filling.Key words: regional ventricular function, diastolic suction, elastic properties.

Echocardiography of congenital mitral valve disorders: echocardiographic–morphological comparisons

2014 ◽  
Vol 24 (6) ◽  
pp. 1030-1048 ◽  
Author(s):  
Norman H. Silverman
Keyword(s):  
Mitral Valve ◽  
Papillary Muscle ◽  
Mitral Stenosis ◽  
Congenital Abnormalities ◽  
High Morbidity ◽  
Papillary Muscles ◽  
Anatomical Correlation ◽  
Mitral Prolapse ◽  
Autopsy Specimens ◽  
Double Orifice

AbstractI surveyed our echocardiographic database of the years between 1998 and 2012 for congenital abnormalities of the mitral valve in patients over 14 years. A total of 249 patients with mitral valve abnormalities were identified. Abnormalities included clefts in the mitral valve in 58 patients, double orifice of the mitral valve in 19, mitral stenosis with two papillary muscles in 72, and mitral stenosis with one papillary muscle in 51 patients. Supravalvar rings were found in 35 patients with a single papillary muscle, and mitral stenoses with two papillary muscles were found in 22 patients. Mitral prolapse occurred in 44 patients and mitral valvar straddle in five patients. The patients were evaluated by all modalities of ultrasound available over the course of time. Although some lesions were isolated, there were many lesions in which more than one mitral deformity presented in the same patient. The patients are presented showing anatomical correlation with autopsy specimens, some of which came from the patients in this series, and others matched to show correlative anatomy. These lesions remain rare as a group and continue to have high morbidity and mortality.

scholarly journals Reconstructive operations on subvalvular structures of the mitral valve during remodelling of the left ventricle. Papillary muscle interventions

2020 ◽  
Vol 24 (3) ◽  
pp. 32
Author(s):  
I. I. Skopin ◽  
M. S. Latyshev
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Conflict Of Interest ◽  
Reconstruction Technique ◽  
Type Iiib ◽  
Reconstructive Operations ◽  
Reverse Remodelling ◽  
Secondary Mitral Regurgitation

<p>The optimal treatment strategy for secondary mitral regurgitation of type IIIb (A. Carpentier classification) remains debatable. The use of a standard surgical technique for treating secondary mitral regurgitation and undersized ring annuloplasty demonstrates suboptimal results in several patients (about 30% of the patients exhibit postoperative hemodynamically significant mitral regurgitation with the absence of effective reverse remodelling of the left ventricle). Such suboptimal results are associated with the unification of only the mitral valve reconstruction technique, irrespective of the state of the left ventricle (degree of dysfunction, dilatation, tethering/tenting, and papillary muscle displacement); this is not entirely justified because of the disease complexity (valve and ventricular), and it is crucial to influence both the components of the disease. Particularly, modern researchers are inclined toward the need of using additional reconstructive interventions on the subvalvular structures that contribute to a more effective reverse remodelling of the left ventricle.<br />Here, we present a review of recent studies on the surgical treatment of functional mitral insufficiency of type IIIb (A. Carpentier classification) with effects on the subvalvular structures (pupillary muscle relocation and approximation).</p><p>Revised 19 April 2020. Revised 5 May 2020. Accepted 28 May 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

P365Does papillary muscle ablation affect mitral valve function: a single centre experience

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
J Stassen ◽  
D Dilling ◽  
J Vijgen ◽  
J Schurmans ◽  
P Koopman
Keyword(s):  
Mitral Valve ◽  
Papillary Muscle ◽  
Delayed Enhancement ◽  
Papillary Muscles ◽  
Premature Ventricular Contractions ◽  
Valve Function ◽  
History Of ◽  
Study Population ◽  
The Impact

Abstract Introduction Ventricular arrhythmias from papillary muscles (PMs) often require extensive catheter ablation (CA). Not much is known about the mitral valve (MV) function after these extensive catheter ablations. Purpose The goal of this study was to determine the impact of papillary muscle CA on MV function.  Methods We retrospectively examined echocardiographic measurements in 21 patients with frequent premature ventricular contractions (PVCs) originating from the mitral PMs who underwent CA, dating from October 2012 till November 2018. We assessed MV function at baseline, 6 month and last follow-up. Degree of mitral regurgitation (MR) was graded as mild (ERO &lt;0,2 cm2, regurgitation volume (RV) &lt;30ml), moderate (ERO 0,2-0,4cm2, RV 30-59ml) or severe (ERO ≥0,4cm2, RV  ≥60ml). Significant MR was defined as a 2+ change. Results Mean age of the study population was 59,7 (27-80)years, 52,4% was female. 2 patients were known with ischemic heart disease. There was a family history of sudden cardiac death in 3 patients. Main symptoms at presentation were palpitations (66,7%), fatigue (33,3%), dyspnea (33,3%, all NYHA 2), dizziness (28,6%), angina pectoris (14,3%) and syncope (4,8%). Beta blocker (71,4%), flecaïnide (23,8%), amiodarone (9,5%), sotalol (4,8%) and propafenon (4,8%) were the most frequent medical therapies before CA. Mean burden of PVC before ablation was 15 574 (2000-39700)/24h. In 28,6% non sustained VT was documented, 1 patient suffered a sustained episode of VT.  After ablation, mean burden of PVC was reduced to 1331 (0-14200)/24h. Redo ablation was necessary in 28,6% of patients. PVCs orginated from the anterolateral PM in 33,3% and from the posteromedial PM in 66,7%. Mean troponin release was 9.4 ± 5.3 µg/l, mean troponin hs (since 2016) was 1591.0 ±658.6ng/ml. CMR was done in 14/21 (66,7%) patients before CA. In 5 out of 14 patients (35,7%), delayed enhancement at the papillary muscles was noticed. In 5 patients without delayed enhancement, CMR was repeated after CA. In all these 5 patients, delayed enhancement was noticed at the level of the papillary muscles.  At baseline, 15/21 had mild, 5/21 moderate and  1/21 severe MR. There was no significant chance in MR at 6m follow-up with 15/21 having mild and  6/21 moderate MR (p 0.58) with 1 patient having a significant MR 2+ change. At last follow-up (23.7 ± 22.6 months) there was also no significant chance in MR with 15/21 having mild and 6/21 moderate MR (p 0.58) without a significant MR 2+ change.  Complications occurred in 1 patient (transient AV blok). No patients died during follow up.  Conclusions Although PM ablation was associated with time extensive ablation, significant troponine release and documented delayed enhancement on post ablation MRI, there was no risk of additional valvular dysfunction after CA in this study. Larger studies will be necessary to confirm these findings.

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