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The Mitral Valve Complex: Divine Perfection

The characteristic term mitral valve for the left atrioventricular valve was first suggested by Andreas Vesalius because of its resemblance to a bishop’s miter. The mitral valve has 2 leaflets with different shapes and circumferential lengths, and these leaflets act together to prevent back flow to the left atrium during the ventricular systole. The anterior leaflet, which is in fibrous continuity with the aortic valve, occupies one third of the annular circumference with a rounded free edge. The posterior leaflet is long, narrow, and composed of 3 distinct scallops—medial, middle, and lateral—that line the remainder of the circumference of the annulus

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Articles of Interest

Anatomy of Mitral Valve Complex as Revealed by Non-Invasive Imaging: Pathological, Surgical and Interventional Implications

Knowledge of mitral valve (MV) anatomy has been accrued from anatomic specimens derived by cadavers, or from direct inspection during open heart surgery. However, today two-dimensional and three-dimensional transthoracic (2D/3D TTE) and transesophageal echocardiography (2D/3D TEE), computed tomography (CT) and cardiac magnetic resonance (CMR) provide images of the beating heart of unprecedented quality in both two and three-dimensional format.

Anatomy of the mitral valve

According to Walmsley, it was Andreas Vesalius who suggested the picturesque term “mitral” to describe the left atrioventricular valve owing to its resemblance to a plan view of the bishop’s mitre. Guarding the inlet to the left ventricle, the mitral valve prevents backflow to the left atrium during ventricular systole. In its open state, the valvar leaflets are like a funnel extending from the hinge line at the atrioventricular junction to the free margins.

Anatomy of the Mitral Valve Apparatus – Role of 2D and 3D Echocardiography

The mitral valve apparatus is a complex three–dimensional functional unit that is critical to unidirectional heart pump function.

Anatomy of the Mitral Valvular Complex and Its Implications for Transcatheter Interventions for Mitral Regurgitation

It was the Belgian anatomist and physician Andreas Vesalius, while working in Padua, Italy, who likened the bifoliate left atrioventricular valve to a bishop's mitre, hence the term “mitral valve”. The physiology of the working components of the valve, its 2 leaflets, can be understood only when note is taken of their crucial relationships to the adjacent anatomical structures...

Medications and the Mitral Valve

As of right now, medical research is not close to finding a medicine that can treat mitral valve disease. However, some medications, through studies, have shown some benefits for mitral valve disease patients. For a patient with mitral valve prolapse, beta-blocker metoprolol has been shown to potentially prevent the heart function from worsening over time. Some patients on this medicine were less likely to need surgery during their time on it. Studies published in the Journal of the American College of Cardiology suggested that beta-blocker therapy may help patients with mitral valve prolapse and leaky valves. However, more trials are being done. Beta-blockers and ACE inhibitors may also help with reducing an enlarged heart back to its normal size.

Mitral Valve Anatomy

Of all the structures of the heart to image with echocardiography, few are as challenging as the mitral valve. Adding to this complexity is the strong support for mitral valve repair in patients with non-ischemic mitral valve disease. It is fair to say that having an excellent command of how to evaluate a mitral valve in the perioperative period is a valuable skill.

Mitral valve anatomy: pre-procedural screening and imaging techniques

The MV has two leaflets, named anterior and posterior, attached at its base to the mitral annulus and to the subvalvular apparatus from its free edges by means of the chordae tendinae. The anterior leaflet has a trapezoidal shape and occupies one third of the annular circumference. The posterior mitral leaflet, quadrangular-shaped, takes up the remaining two thirds of the annulus.

Mitral valve and mitral valve disease

The mitral valve is a complex structure that incorporates not only the two main leaflets, but an annulus, tendinous cords, and papillary muscles connecting the valve leaflets to the LV.

Mitral valve disease—morphology and mechanisms

Mitral valve disease is a frequent cause of heart failure and death. Emerging evidence indicates that the mitral valve is not a passive structure, but—even in adult life—remains dynamic and accessible for treatment. This concept motivates efforts to reduce the clinical progression of mitral valve disease through early detection and modification of underlying mechanisms.

Recent advances in understanding and managing mitral valve disease

Interest in the mitral valve has increased over the past few years with the development of new technologies that allow intervention in patients previously deemed too ill for treatment. This increased attention has resulted in a significant increase in publications on the mitral valve, the majority of which focus on mitral regurgitation and mitral valve surgery/intervention.

StatPearls

The main feature of the mitral valve is the mitral apparatus, which is composed of the left atrial wall, left ventricle wall, the mitral annulus, the anterior and posterior leaflets, chordae tendinae and papillary muscles.

The mechanobiology of mitral valve function, degeneration, and repair

The mitral valve is a unique tissue exposed to a complex mechanical environment, and while pathogenesis of the mitral valve is caused by many factors, it has become increasingly apparent that changes in the mechanics of the valve or its environment have great impact on degeneration.

The Mitral Valve Anatomy and Pathology for the Surgeon

The mitral valve in the normal adult consists of 2 tough, membranous, elastic, extremely thin and pliable leaflets anchored at their bases to the annulus. Numerous slender tendinous chords are attached at the margins of their ventricular surfaces.

Resources

Radiopaedia

The mitral valve (MV) (or bicuspid valve) is one of the four cardiac valves. It is the atrioventricular valve that allows blood to flow from the left atrium to the left ventricle. It opens during diastole and closes during systole.

The Anatomy of the Mitral Valve

As was emphasised several decades ago by Perloff and Roberts, the mitral valve is best considered in terms of a valvar complex.