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J Thorac Cardiovasc Surg 1999;118:636-641
© 1999 Mosby, Inc.
SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE |
From the Department of Cardiovascular Surgery, Tenri Hospital, Nara,a Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka,b Department of Thoracic Surgery, Nagoya University, Nagoya,c and Department of Cardiovascular Surgery, Kishiwada City Hospital, Osaka,d Japan.
Address for reprints: Tetsuro Sakai, MD, Division of Cardiovascular Surgery, The Toronto Hospital, 13 EN-222, Toronto, Ontario, Canada M5G 2C4 (E-mail: tedsakai{at}hotmail.com).
Background: Preservation of the annulo–papillary muscle continuity in mitral valve replacement is important. Even in patients who require excision of the mitral apparatus, the continuity can be restored. However, there is no guide to the proper length for the resuspension.
Methods: In 57 normal cadaveric hearts, the distance from the tip of the papillary muscle to its corresponding mitral anulus was directly measured.
Results: The distance from the tip of the anterolateral papillary muscle to the left trigone (10-o’clock position: D10) and to the point between the anterior and the middle scallops of the mural leaflet (8-o’clock position: D8) was 23.5 ± 3.7 mm and 23.2 ± 3.6 mm, respectively. The distance from the tip of the posteromedial papillary muscle to the right trigone (2-o’clock position: D2) and to the point between the middle and the posterior scallops of the mural leaflet (4-o’clock position: D4) was 23.5 ± 4.0 mm and 23.5 ± 3.9 mm, respectively. There was no statistically significant difference among the 4 distances (P = .96). Each distance was significantly longer than the corresponding chordae tendineae (D10 vs the anterior main chorda: 17.2 ± 3.9 mm, D8 vs the anterior cleft chorda: 14.5 ± 3.2 mm, D2 vs the posterior main chorda: 17.9 ± 4.3 mm, and D4 vs the posterior cleft chorda: 14.9 ± 3.2 mm, respectively; P = .0001). The mean distance had a significant correlation with the mitral annular diameter (r = 0.31, P = .019).
Conclusions: In normal hearts, the annulo–papillary muscle distances of the mitral apparatus are similar in 2-, 4-, 8-, and 10-o’clock positions and correlate with the mitral annular diameter.
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