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J Thorac Cardiovasc Surg 2009;137:1077-1081
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Mitral leaflet anatomy revisited

Jason L. Quill, BSa, Alexander J. Hill, PhDb, Timothy G. Laske, PhDb, Ottavio Alfieri, MDc, Paul A. Iaizzo, PhDa,*

a Departments of Surgery and Biomedical Engineering, University of Minnesota, Minneapolis, Minn
b Medtronic, Inc, Minneapolis, Minn
c San Raffaele Hospital of Milan, Milan, Italy

Received for publication May 15, 2008; revisions received August 25, 2008; accepted for publication October 8, 2008.

* Address for reprints: Paul A. Iaizzo, PhD, Department of Surgery, University of Minnesota, B172 Mayo, MMC 107, 420 Delaware Street SE, Minneapolis, MN 55455. (Email: iaizz001{at}umn.edu).

Objective: The aims of this work were to employ functional imaging capabilities of the Visible Heart laboratory and endoscopic visualization of mitral valves in perfusion-fixed specimens to better characterize variability in mitral valve leaflet anatomy and to provide a method to classify mitral leaflets that varies from the current nomenclature.

Methods: We gathered functional endoscopic video footage (11 isolated reanimated human hearts) and static endoscopic anatomical images (38 perfusion-fixed specimens) of mitral leaflets. Commissure and cleft locations were charted using Carpentier's accepted description.

Results: All hearts had 2 commissures separating anterior and posterior leaflets. "Standard" clefts separating P1/P2 were found in 66% of hearts (n = 25), and standard clefts separating P2/P3 were present in 71% of hearts (n = 27). "Deviant" clefts occurred in each region of the anterior leaflet (A1, A2, A3), and their relative occurrences were 5%, 8%, and 13% (n = 2, 3, 5), respectively. Deviant clefts were found in posterior leaflets: 13.2% in P1 (n = 5), 32% in P2 (n = 12), and 21% in P3 (n = 8).

Conclusions: Humans elicit complex and highly variable mitral valve anatomy. We suggest a complementary, yet simple nomenclature to address variation in mitral valve anatomy by describing clefts as either standard or deviant and locating regions in which they occur (A1 to A3 or P1 to P3).






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