Advertisement

Mitral Valve

  • Michael Y. HeneinEmail author
  • Mary Sheppard
  • John R. Pepper
  • Michael Rigby
Chapter
  • 3.1k Downloads

Abstract

The mitral valve is composed of two leaflets, an annulus, chordae tendineae, and two papillary muscles. The anterior (aortic) leaflet is attached to the root of the aorta in direct continuity with the aortic valve and the membranous septum, and has a rectangular shape involving one-third of the ­circumference of the annulus. The posterior leaflet is continuous with the posterior wall of the left atrium and is longer than the anterior leaflet occupying two-thirds of the circumference of the mitral annulus.

Keywords

Mitral Valve Mitral Regurgitation Papillary Muscle Mitral Stenosis Mitral Valve Replacement 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 1.1

Apical 4 chamber view showing normal mitral valve

Video 1.avi (7,267 KB)

Video 1.2

Apical 3D apical view

Video 2.avi (11,707 KB)

Video 1.3

Parasternal long axis view from a patient with rheumatic MV leaflets

Video 3.avi (4,369 KB)

Video 1.4

Parasternal short axis view from the same patient

Video 4.avi (6,822 KB)

76621_2_En_1_MOESM5_ESM.mpg (2.2 mb)
Video 1.5 Transesophageal 4 chamber view from a patient with rheumatic MV disease and spontaneous echo contrast in the left atrium Video 5.avi (2,267 KB)
Video 1.6

Balloon valvuloplasty procedure in a patient with severe rheumatic mitral stenosis

video 6.mpg (3,087 KB)

76621_2_En_1_MOESM7_ESM.mpg (2.5 mb)
Video 1.7 Rheumatic mitral and aortic valve disease video 07.avi (2,546 KB)
Video 1.8

Rheumatic mitral and aortic valve disease- color Doppler

video 08.avi (972 KB)

76621_2_En_1_MOESM9_ESM.mpg (1.6 mb)
Video 1.9 Apical 4 chamber view from a patient with rheumatic mitral and tricuspid valve disease video 09.avi (1,686 KB)
Video 1.10

Parasternal 3D images showing anterior mitral valve leaflet prolapsed

video 10.avi (3,867 KB)

Video 1.11

Transesophageal images from a patient with posterior mitral leaflet prolapse due to ruptured chordate

video 11.avi (3,582 KB)

Video 1.12

Transesophgeal images from the same patient showing color Doppler mitral regurgitation

video 12.avi (1,704 KB)

76621_2_En_1_MOESM13_ESM.mpg (2.9 mb)
Video 1.13 Transesophageal images from a patient with posterior mitral leaflet prolapse and redundant anterior leaflet video 13.avi (2,979KB)
76621_2_En_1_MOESM14_ESM.mpg (1.4 mb)
Video 1.14 Transesophageal images from the same patient with color Doppler demonstrating the severity of mitral regurgitation video 14.avi (1,441 KB)
Video 1.15

Parasternal short axis 3D images showing anterior and posterior mitral leaflet prolapsed

video 15.avi (9,232 KB)

76621_2_En_1_MOESM16_ESM.mpg (1.6 mb)
Video 1.16 Apical views showing color Doppler 3D images of mild mitral regurgitation video 16.avi (1,595 KB)
76621_2_En_1_MOESM17_ESM.mpg (2.1 mb)
Video 1.17 Apical views showing color Doppler 3D images of severe mitral regurgitation video 12.avi (2,117 KB)

References

  1. 1.
    Daniels SJ, Mintz GS, Kotler MN. Rheumatic tricuspid valve ­disease: two-dimensional echocardiographic, hemodynamic, and angiographic correlations. Am J Cardiol. 1983;51(3):492–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Kilner PJ, Henein MY, Gibson DG. Our tortuous heart in dynamic mode – an echocardiographic study of mitral flow and movement in exercising subjects. Heart Vessels. 1997;12(3):103–10.PubMedCrossRefGoogle Scholar
  3. 3.
    Henein M, Lindqvist P, Francis D, Morner S, Waldenstrom A, Kazzam E. Tissue Doppler analysis of age-dependency in diastolic ventricular behaviour and filling: a cross-sectional study of healthy hearts (the Umea General Population Heart Study). Eur Heart J. 2002;23(2):162–71.PubMedCrossRefGoogle Scholar
  4. 4.
    Come PC, Riley MF. M mode and cross-sectional echocardiographic recognition of fibrosis and calcification of the mitral valve chordae and left ventricular papillary muscles. Am J Cardiol. 1982;49(2):461–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Naito M, Morganroth J, Mardelli TJ, Chen CC, Dreifus LS. Rheumatic mitral stenosis:cross-sectional echocardiographic analysis. Am Heart J. 1980;100(1):34–40.PubMedCrossRefGoogle Scholar
  6. 6.
    Pellikka PA, Tajik AJ, Khandheria BK, Seward JB, Callahan JA, Pitot HC, et al. Carcinoid heart disease. Clinical and echocar­diographic spectrum in 74 patients. Circulation. 1993;87(4):1188–96.PubMedGoogle Scholar
  7. 7.
    Gibson DG. Valve disease. In: Weatherall DJ, Ledingham JGG, Warrell DA, editors. Oxford textbook of medicine. New York: Oxford University Press; 1996. p. 2451.Google Scholar
  8. 8.
    Smith MD, Handshoe R, Handshoe S, Kwan OL, DeMaria AN. Comparative accuracy of two-dimensional echocardiography and Doppler pressure half-time methods in assessing severity of mitral stenosis in patients with and without prior commissurotomy. Circulation. 1986;73(1):100–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Kawahara T, Yamagishi M, Seo H, Mitani M, Nakatani S, Beppu S, et al. Application of Doppler color flow imaging to determine valve area in mitral stenosis. J Am Coll Cardiol. 1991;18(1):85–92.PubMedCrossRefGoogle Scholar
  10. 10.
    Deng YB, Matsumoto M, Wang XF, Liu L, Takizawa S, Takekoshi N, et al. Estimation of mitral valve area in patients with mitral stenosis by the flow convergence region method: selection of aliasing velocity. J Am Coll Cardiol. 1994;24(3):683–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Nishimura RA, Rihal CS, Tajik AJ, Holmes Jr DR. Accurate measurement of the transmitral gradient in patients with mitral stenosis: a simultaneous catheterization and Doppler echocardiographic study. J Am Coll Cardiol. 1994;24(1):152–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Hatle L, Angelsen B, Tromsdal A. Noninvasive assessment of atrioventricular pressure half-time by Doppler ultrasound. Circulation. 1979;60(5):1096–104.PubMedGoogle Scholar
  13. 13.
    Hatle L, Angelsen BA. Doppler ultrasound in cardiology. 2nd ed. Philadelphia: Lea & Febiger; 1985.Google Scholar
  14. 14.
    Nakatani S, Masuyama T, Kodama K, Kitabatake A, Fujii K, Kamada T. Value and limitations of Doppler echocardiography in the quantification of stenotic mitral valve area: comparison of the pressure half-time and the continuity equation methods. Circulation. 1988;77(1):78–85.PubMedCrossRefGoogle Scholar
  15. 15.
    Shrestha NK, Moreno FL, Narciso FV, Torres L, Calleja HB. ­Two-dimensional echocardiographic diagnosis of left-atrial thrombus in rheumatic heart disease. A clinicopathologic study. Cir­culation. 1983;67(2):341–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Iliceto S, Antonelli G, Sorino M, Biasco G, Rizzon P. Dynamic intracavitary left atrial echoes in mitral stenosis. Am J Cardiol. 1985;55(5):603–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Gibson DG, Brown D. Measurement of instantaneous left ventricular dimension and filling rate in man, using echocardiography. Br Heart J. 1973;35(11):1141–9.PubMedCrossRefGoogle Scholar
  18. 18.
    John Sutton MG, Traill TA, Ghafour AS, Brown DJ, Gibson DG. Echocardiographic assessment of left ventricular filling after mitral valve surgery. Br Heart J. 1977;39(12):1283–91.CrossRefGoogle Scholar
  19. 19.
    Desideri A, Vanderperren O, Serra A, Barraud P, Petitclerc R, Lesperance J, et al. Long-term (9 to 33 months) echocardiographic follow-up after successful percutaneous mitral commissurotomy. Am J Cardiol. 1992;69(19):1602–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Weyman AE, Heger JJ, Kronik TG, Wann LS, Dillon JC, Feigenbaum H. Mechanism of paradoxical early diastolic septal motion in patients with mitral stenosis: a cross-sectional echocardiographic study. Am J Cardiol. 1977;40(5):691–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Veyrat C, Kalmanson D, Farjon M, Manin JP, Abitbol G. Non-invasive diagnosis and assessment of tricuspid regurgitation and stenosis using one and two dimensional echo-pulsed Doppler. Br Heart J. 1982;47(6):596–605.PubMedCrossRefGoogle Scholar
  22. 22.
    Waller BF. Morphological aspects of valvular heart disease: part II. Curr Probl Cardiol. 1984;9(8):1–74.CrossRefGoogle Scholar
  23. 23.
    Abascal VM, Wilkins GT, O’Shea JP, Choong CY, Palacios IF, Thomas JD, et al. Prediction of successful outcome in 130 patients undergoing percutaneous balloon mitral valvotomy. Circulation. 1990;82(2):448–56.PubMedCrossRefGoogle Scholar
  24. 24.
    Palacios IF, Block PC, Wilkins GT, Weyman AE. Follow-up of patients undergoing percutaneous mitral balloon valvotomy. Analysis of factors determining restenosis. Circulation. 1989;79(3):573–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Wilkins GT, Weyman AE, Abascal VM, Block PC, Palacios IF. Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br Heart J. 1988;60(4):299–308.PubMedCrossRefGoogle Scholar
  26. 26.
    Roberts WC. Morphologic features of the normal and abnormal mitral valve. Am J Cardiol. 1983;51(6):1005–28.PubMedCrossRefGoogle Scholar
  27. 27.
    Savage DD, Garrison RJ, Castelli WP, McNamara PM, Anderson SJ, Kannel WB, et al. Prevalence of submitral (anular) calcium and its correlates in a general population-based sample (the Framingham study). Am J Cardiol. 1983;51(8):1375–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Segal BL, Likoff W, Kingsley B. Echocardiography. Clinical application in mitral regurgitation. Am J Cardiol. 1967;19(1):50–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Pomerance A. Pathological and clinical study of calcification of the mitral valve ring. J Clin Pathol. 1970;23(4):354–61.PubMedCrossRefGoogle Scholar
  30. 30.
    Waller BF, Morrow AG, Maron BJ, Del Negro AA, Kent KM, McGrath FJ, et al. Etiology of clinically isolated, severe, chronic, pure mitral regurgitation: analysis of 97 patients over 30 years of age having mitral valve replacement. Am Heart J. 1982;104(2 Pt 1):276–88.PubMedCrossRefGoogle Scholar
  31. 31.
    Castello R, Lenzen P, Aguirre F, Labovitz AJ. Quantitation of mitral regurgitation by transesophageal echocardiography with Doppler color flow mapping: correlation with cardiac catheterization. J Am Coll Cardiol. 1992;19(7):1516–21.PubMedCrossRefGoogle Scholar
  32. 32.
    Upton MT, Gibson DG. The study of left ventricular function from digitized echocardiograms. Prog Cardiovasc Dis. 1978;20(5):359–84.PubMedCrossRefGoogle Scholar
  33. 33.
    Mintz GS, Kotler MN, Segal BL, Parry WR. Two dimensional echocardiographic evaluation of patients with mitral insufficiency. Am J Cardiol. 1979;44(4):670–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Panidis IP, McAllister M, Ross J, Mintz GS. Prevalence and severity of mitral regurgitation in the mitral valve prolapse syndrome: a Doppler echocardiographic study of 80 patients. J Am Coll Cardiol. 1986;7(5):975–81.PubMedCrossRefGoogle Scholar
  35. 35.
    Abbasi AS, Allen MW, DeCristofaro D, Ungar I. Detection and estimation of the degree of mitral regurgitation by range-gated pulsed Doppler echocardiography. Circulation. 1980;61(1):143–7.PubMedGoogle Scholar
  36. 36.
    Helmcke F, Nanda NC, Hsiung MC, Soto B, Adey CK, Goyal RG, et al. Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation. 1987;75(1):175–83.PubMedCrossRefGoogle Scholar
  37. 37.
    Miyatake K, Izumi S, Okamoto M, Kinoshita N, Asonuma H, Nakagawa H, et al. Semiquantitative grading of severity of mitral regurgitation by real-time two-dimensional Doppler flow imaging technique. J Am Coll Cardiol. 1986;7(1):82–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Spain MG, Smith MD, Grayburn PA, Harlamert EA, DeMaria AN. Quantitative assessment of mitral regurgitation by Doppler color flow imaging: angiographic and hemodynamic correlations. J Am Coll Cardiol. 1989;13(3):585–90.PubMedCrossRefGoogle Scholar
  39. 39.
    Eren M, Eksik A, Gorgulu S, Norgaz T, Dagdeviren B, Bolca O, et al. Determination of vena contracta and its value in evaluating severity of aortic regurgitation. J Heart Valve Dis. 2002;11(4):567–75.PubMedGoogle Scholar
  40. 40.
    Klein AL, Obarski TP, Stewart WJ, Casale PN, Pearce GL, Husbands K, et al. Transesophageal Doppler echocardiography of pulmonary venous flow: a new marker of mitral regurgitation severity. J Am Coll Cardiol. 1991;18(2):518–26.PubMedCrossRefGoogle Scholar
  41. 41.
    Nishimura RA, Tajik AJ. Determination of left-sided pressure gradients by utilizing Doppler aortic and mitral regurgitant signals: validation by simultaneous dual catheter and Doppler studies. J Am Coll Cardiol. 1988;11(2):317–21.PubMedCrossRefGoogle Scholar
  42. 42.
    Ren JF, Kotler MN, DePace NL, Mintz GS, Kimbiris D, Kalman P, et al. Two-dimensional echocardiographic determination of left atrial emptying volume: a noninvasive index in quantifying the degree of nonrheumatic mitral regurgitation. J Am Coll Cardiol. 1983;2(4):729–36.PubMedCrossRefGoogle Scholar
  43. 43.
    Bargiggia GS, Tronconi L, Sahn DJ, Recusani F, Raisaro A, De Servi S, et al. A new method for quantitation of mitral regurgitation based on color flow Doppler imaging of flow convergence proximal to regurgitant orifice. Circulation. 1991;84(4):1481–9.PubMedGoogle Scholar
  44. 44.
    Humphries Jr WC, Hammer WJ, McDonough MT, Lemole G, McCurdy RR, Spann Jr JF. Echocardiographic equivalents of a flail mitral leaflet. Am J Cardiol. 1977;40(5):802–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Mintz GS, Kotler MN, Segal BL, Parry WR. Two-dimensional echocardiographic recognition of ruptured chordae tendineae. Circulation. 1978;57(2):244–50.PubMedGoogle Scholar
  46. 46.
    Castello R, Lenzen P, Aguirre F, Labovitz AJ. Quantitation of mitral regurgitation by transesophageal echocardiography with Doppler color flow mapping: correlation with cardiac catheterization. J Am Coll Cardiol. 1992;19(7):1516–21.PubMedCrossRefGoogle Scholar
  47. 47.
    Klein AL, Bailey AS, Cohen GI, Stewart WJ, Duffy CI, Pearce GL, et al. Importance of sampling both pulmonary veins in grading mitral regurgitation by transesophageal echocardiography. J Am Soc Echocardiogr. 1993;6(2):115–23.PubMedGoogle Scholar
  48. 48.
    Zile MR, Gaasch WH, Carroll JD, Levine HJ. Chronic mitral regurgitation: predictive value of preoperative echocardiographic indexes of left ventricular function and wall stress. J Am Coll Cardiol. 1984;3(2 Pt 1):235–42.PubMedCrossRefGoogle Scholar
  49. 49.
    Czer LS, Maurer G, Bolger AF, De Robertis M, Resser KJ, Kass RM, et al. Intraoperative evaluation of mitral regurgitation by Doppler color flow mapping. Circulation. 1987;76(3 Pt 2):III108–16.PubMedGoogle Scholar
  50. 50.
    Reichert SL, Visser CA, Moulijn AC, Suttorp MJ, vd Brink RB, Koolen JJ, et al. Intraoperative transesophageal color-coded Doppler echocardiography for evaluation of residual regurgitation after mitral valve repair. J Thorac Cardiovasc Surg. 1990;100(5):756–61.PubMedGoogle Scholar
  51. 51.
    Moises VA, Maciel BC, Hornberger LK, Murillo-Olivas A, Valdes-Cruz LM, Sahn DJ, et al. A new method for noninvasive estimation of ventricular septal defect shunt flow by Doppler color flow ­mapping: imaging of the laminar flow convergence region on the left septal surface. J Am Coll Cardiol. 1991;18(3):824–32.PubMedCrossRefGoogle Scholar
  52. 52.
    Recusani F, Bargiggia GS, Yoganathan AP, Raisaro A, Valdes-Cruz LM, Sung HW, et al. A new method for quantification of regurgitant flow rate using color Doppler flow imaging of the flow convergence region proximal to a discrete orifice. An in vitro study. Circulation. 1991;83(2):594–604.PubMedGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  • Michael Y. Henein
    • 1
    Email author
  • Mary Sheppard
    • 2
  • John R. Pepper
    • 2
  • Michael Rigby
    • 2
  1. 1.Department of Public Health and Clinical Medical and Heart CenterUmea UniversityUmeaSweden
  2. 2.Royal Brompton HospitalLondonUK

Personalised recommendations