Ann Thorac Surg 2007;84:1255
© 2007 The Society of Thoracic Surgeons
Original Articles: Cardiovascular
Invited commentary
Joseph H. Gorman, III, MD
University of Pennsylvania School of Medicine, 313 Stemmler Hall, 36th and Hamilton Walk, Philadelphia, PA 19104-4283
(Email: gormanj{at}uphs.upenn.edu).
Mitral valve anatomy has been studied extensively since Vesalius first gave the valve its name 500 years ago. Despite this, a growing realization that mitral repair durability is not as robust as was once believed has stimulated surgeons to analyze valve structure with a more quantitative eye. Toward this end, Degandt and colleagues [1] report a simple, yet well done study describing comparative basal chord anatomy.
Theoretical studies have shown leaflet curvature to be an important determinant of leaflet stress and leaflet stress a potential determinate of repair durability [2, 3]. In addition, recent studies by our group using real-time three-dimensional echocardiography (rt3DE) have revealed mitral leaflet curvature to be much more complex than previously believed (unpublished data). A particularly interesting result of these early rt3DE studies has been to show the mid-posterior leaflet (P2) to be a region of dense curvature heterogeneity. Such spatially dense surface curvature changes have been correlated with an increased stress distribution in aortic aneurysms [4]. This may explain why the P2 region is the most common location for valve disruption in patients with myxomatous degeneration.
Complex leaflet geometry is, at least in part, a function of the intricate chordal insertion pattern that this article describes thoroughly for the first time. The results of this study should not be underestimated. The information provided will not only be helpful in interpreting 3D valve imaging, but it will facilitate the development of more accurate computer models of functional valve anatomy. As these models evolve they will ultimately be used to develop, optimize, and evaluate repair techniques. Such a tool will allow the surgeon to quantitatively plan a mitral valve repair operation before he or she enters the operating room.
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References
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- Degandt AA, Weber PA, Saber HA, Duran CMG. Mitral valve basal chordae: comparative anatomy and terminology Ann Thorac Surg 2007;84:1250-1255.[Abstract/Free Full Text]
- Salgo IS, Gorman 3rd JH, Gorman RC, et al. Effect of annular shape on leaflet curvature in reducing mitral leaflet stress Circulation 2002;106:711-717.[Abstract/Free Full Text]
- Arts T, Meerbaum S, Reneman R. Stresses in the closed mitral valve: a model study J Biomech 1983;16:539-547.[Medline]
- Sacks MS, Vorp DA, Raghavan ML, Federle MP, Webster MW. In vivo three-dimensional surface geometry of abdominal aortic aneurysms Ann Biomed Eng 1999;27:469-479.[Medline]
Related Article
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Mitral Valve Basal Chordae: Comparative Anatomy and Terminology
- Alexandra A. Degandt, Patricia A. Weber, Hashim A. Saber, and Carlos M.G. Duran
Ann. Thorac. Surg. 2007 84: 1250-1255.
[Abstract]
[Full Text]
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