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Biaxial Mechanical Characterizations of Atrioventricular Heart Valves
Published on: April 9, 2019
Morphological study of chordae tendinae in human cadaveric hearts
S A Gunnal1, R N Wabale1, M S Farooqui1
1Department of Anatomy, Rural Medical College, Maharashtra, India.
Insights
This study classified over 21 types of chordae tendineae (CT) in human hearts, detailing their structure and variations. Understanding these complex CT structures is crucial for cardiac surgeons performing mitral valve repair and replacement.
Area of Science:
- Cardiovascular Anatomy
- Cardiac Surgery Research
- Medical Imaging and Diagnostics
Background:
- Chordae tendineae (CT) are vital fibrous connections linking valve leaflets to papillary muscles.
- Dysfunction of papillary muscles and CT is a common issue.
- Preserving CT and papillary muscles during mitral valve replacement may improve postoperative left ventricular function in chronic mitral regurgitation.
Purpose of the Study:
- To classify and define the diverse terminologies and structures of chordae tendineae.
- To provide detailed anatomical insights into the origin, attachments, and distribution of CT.
- To enhance understanding for improved surgical interventions in mitral valve disease.
Main Methods:
- Analysis of 116 human cadaveric hearts.
- Detailed gross observation and study of CT constituents via atrioventricular valve.
- Classification based on origin, attachments, distribution, branching pattern, and gross structure.
Main Results:
- Defined over 21 terminologies of CT, categorized into six types.
- Identified specific types like Basal pillar chordae (9.48%), Strut chordae with aponeurosis (38.79%), and muscular/membranous chordae (14% and 6%).
- Quantified mean numbers of chordae originating from papillary muscles and attaching to cusps.
Conclusions:
- The detailed classification and understanding of chordae tendineae anatomy are essential.
- This anatomical knowledge is valuable for cardiologists and cardiac surgeons.
- Informed surgical approaches, particularly during mitral valve procedures, can benefit from this detailed CT morphology.
Objectives:
The chordae tendinae (CT) are strong, fibrous connections between the valve leaflets and the papillary muscles. Dysfunction of the papillary muscles and chordae is frequent. Mitral valve replacement with preservation of CT and papillary muscles may preserve postoperative left ventricular function better than conventional mitral valve replacement in patients with chronic mitral regurgitation.
Methods:
The study was carried out on 116 human cadaveric hearts. The heart was opened through the atrioventricular valve to view the constituents of the complex. Origin, attachments, insertions, distribution, branching pattern and gross structure of CT were observed and studied in detail.
Results:
In the present study more than 21 terminologies of CT were defined by classifying it into six different types. Classification is done according to the origin, attachments, insertion, distribution, branching pattern and gross structure. Terminologies defined are as follows. Apical pillar chordae, Basal pillar chordae, True chordae, False chordae, Interpillar chordae, Pillar wall chordae, Cusp chordae, Cleft chordae, Commissural chordae, First order chordae, Second order chordae, Free zone chordae, Marginal chordae, Rough zone chordae, Straight chordae, Branched-fan shaped chordae, Spiral chordae, Irregular-web chordae, Tendinous chordae, Muscular chordae, Membranous chordae. Basal pillar chordae are found in 9.48%. Mean number of chordae taking origin from apical half of a single papillary muscle or single head of papillary muscle was 9.09 with the range of 3-18. Mean number of the marginal chordae attached to a single cusp was 22.63 ranging from 11 to 35. Strut chordae showed interesting insertion with broad aponeurosis in 38.79% and large muscular flaps in 13.79%. Chordae muscularis were found in 14% and membranous chordae were found in 6%.
Conclusions:
This knowledge may prove useful for cardiologists and cardiac surgeons.
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