[Morphological observation of the mitral annulus fibrosus (II)]

In 1986, Hutchins observed a high incidence of the disjunction of the mitral annulus fibrosus in mitral valve prolapse syndrome. However, we could not prove his view in our previous study using one section in each case. In this study, the types of mitral annulus fibrosus were analyzed in plural sections. Autopsy hearts of nine aged cases were used for examination of the mitral annulus fibrosus in five to eight longitudinal sections from the posterolateral wall. The types of the mitral annulus fibrosus were classified as; Type A (the mitral valve attaches to the left ventricle), Type B (the valve attaches to the left atrium), Type C (the atrialis layer of the valve continues to the left atrium, while the fibrosa layer continues to the left ventricle), and type D (mitral annulus calcification). A1-3 and B1-3 are subtypes. In the nine cases there were no consistent patterns in type distributions. All sections showed Type A1 (Case 2), Type A1 to A3 (Case 5), and Type B1 to B3 (Case 8). In other cases, a combination of Type A and B (Case 4, 6, 7, 9), and inclusion of Type C (Case 1) and Type D (Case 3) were found. The location of the middle scallop of the posterior mitral leaflet corresponded to the section of the previous study. Among three cases of Type A in the middle scallop, two showed Type A in every section. Among five cases of Type B in the middle scallop, only one case showed Type B in every section. Other four cases showed various combinations with the other types. A case of Type D in the middle scallop showed also Type B and Type C. The conclusion of this study was that in 1/3 of the cases, the type of the mitral annulus fibrosus was consistent, but in the other 2/3 they were not consistent. In other words, one section is not necessarily representative of the morphology of the mitral annulus fibrosus in each case.