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Anomalous papillary muscle insertion into mitral valve leaflet: Autopsy study and implications

Aleksa Leković1, Vladimir Živković1, Slobodan Nikolić1

  • 1Institute of Forensic Medicine, University of Belgrade - School of Medicine, Belgrade, Serbia.

Journal of Forensic Sciences
|December 8, 2022
PubMed

Insights

Anomalous papillary muscle (APM) insertion is a rare finding, often overlooked, and does not always indicate significant heart pathology. Autopsy analysis helps determine the true significance of this cardiac anomaly.

Area of Science:

  • Cardiovascular Pathology
  • Cardiac Anatomy
  • Forensic Pathology

Background:

  • Anomalous papillary muscle (APM) insertion into the anterior mitral valve leaflet is a rare cardiac finding.
  • While often associated with hypertrophic cardiomyopathy (HCM), APM can occur independently and its hemodynamic significance is not always clear.
  • Interpreting APM at autopsy is challenging due to the dynamic nature of left ventricular outflow tract (LVOT) obstruction.

Purpose of the Study:

  • To analyze autopsy cases of APM to understand its prevalence, types, and association with cardiac morphology and cause of death.
  • To investigate the characteristics of APM, including insertion site, origin, number of bellies, and associated heart measurements.
  • To provide guidance on assessing the significance of APM during post-mortem examinations.

Main Methods:

  • Retrospective analysis of autopsy cases, including systematic examination of hearts.
  • Identification and classification of APM based on insertion site and type.
  • Correlation of APM findings with heart weight, left ventricle (LV) thickness, LV endocardial fibrosis, age, sex, and cause/manner of death.
  • Histological examination in select cases.

Main Results:

  • APM prevalence was found to be 0.9% in systematically examined hearts.
  • Type II APM was most frequent (n=8), followed by Type III (n=7) and Type I (n=5).
  • Subjects who died of natural causes with APM were older and had heavier hearts compared to those with non-natural deaths, but LV thickness did not differ significantly.

Conclusions:

  • APM is a rare cardiac anomaly that can be easily missed during autopsy.
  • The mere presence of APM does not necessarily imply significant pathology or hemodynamic compromise.
  • Proper assessment considering various morphological and clinical factors is crucial for determining the significance of APM at autopsy.
Keywords:
anomalous papillary muscleautopsyforensic pathologyhypertrophic cardiomyopathyleft ventricle outflow tract obstructionmitral valvesudden cardiac death

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