OF THE MITRAL VALVE Mike Poullis 形态的二尖瓣麦克课件.ppt

MORPHOLOGY OF THE MITRAL VALVE M. Kuduvalli ELEMENTS OF MITRAL VALVE APPARATUS Annulus Leaflets Subvalvar apparatus - Chordae tendinae - Papillary muscles MITRAL ANNULUS Zone of junction which serves as attachment to the muscular fibres of the atrium, ventricle, and attachment of the mitral valve Attached to two fibrous trigones -The right fibrous trigone which forms a dense junction between the mitral, tricuspid and aortic (non-coronary cusp) annuli, and the membranous septum -The left fibrous trigone which lies between the aortic (left cusp) and the mitral annuli Between the two trigones, the mitral valve is in continuity with the aortic wall and there is no fibrous mitral annulus in this region FIBROUS SKELETON OF THE HEART SPATIAL RELATIONSHIP BETWEEN MITRAL, AORTIC AND TRICUSPID VALVES MITRAL ANNULUS Mitral annulus is a dynamic structure Has a sphincter like function, effectively decreasing the valve area by about a quarter during systole This is secondary to contraction and relaxation of the basoconstrictor muscles (bulbospiral and sinospiral) Dilatation of the annulus occurs posteriorly IMPORTANT STRUCTURES SURROUNDING THE MITRAL ANNULUS MITRAL LEAFLETS Form a continuous veil attached to the circumference of the mitral annulus Free edge hangs into the LV, and is split by indentations Two well defined and constant indentations: - Anterolateral commissure - Posteromedial commissure MITAL LEAFLETS Commissural areas (identified by presence of commissural chordae) divide the continuous mitral veil into two leaflets: - Anterior (aortic) leaflet - Posterior (mural) leaflet MITRAL LEAFLETS Covered with endocardium Distinct ridge on atrial side which - defines line of leaflet closure - separates leaflets into two zones - rough zone distal to the ridge (represents surface of coaptation) - clear zone proximal to the ridge ANTERIOR MITRAL LEAFLET Semicircular or triangular Attached to around 3/8