The Normal Mitral Valve

  • Sorina Mihaila Baldea
  • Dragos Vinereanu
  • Roberto M. Lang


Accurate characterization of the normal anatomy and function of the mitral valve apparatus is key to understand the pathophysiology of mitral valve diseases. Echocardiography is the first-line imaging technique used for the assessment of the mitral valve morphology and function. During the last five decades, echocardiography has evolved from M-mode to two-dimensional, and then three-dimensional imaging, introducing a new era in the cardiovascular imaging. The use of newly matrix array transthoracic and transesophageal transducers bestowed unique possibilities to assess the mitral valve apparatus in all three or four-dimensions (including time), without the need of offline reconstruction. Heart imagers were able to obtain for the first time “en face” visualization of the mitral valve from the atrial perspective, as only the surgeons were previously able to see it, and to describe in detail the complex anatomy of the valvular and sub-valvular apparatus.

This chapter summarizes the current status of the acquisition and display of the mitral valve using three-dimensional transthoracic and transesophageal echocardiography and describes the normal anatomy of the mitral valve apparatus components.


Normal mitral valve Three-dimensional echocardiography Transesophageal Transthoracic Data set Acquisitions and display Mitral annulus Chordae Papillary muscles 

Supplementary material

Video 7.1

Single-beat 3DE full-volume of the mitral valve and left atrial structures obtained using transesophageal echocardiography. Despite the low temporal resolution of 5 vps, the quality of the data set allows precise assessment of the anatomy of the let atrial structures (AVI 2483 kb)

Video 7.2a

(Left) Mitral valve visualized from the left atrial perspective (so called “surgical view”) (AVI 14245 kb)

Video 7.2b

(Right) The mitral valve visualized from the left ventricular perspective (AVI 13411 kb)

Video 7.3a

(Left) Multibeat 3DE acquisition of a large data set to assess the relationships of the mitral valve with adjacent cardiac structures (aorta, interatrial septum and left atrial appendage) (AVI 6638 kb)

Video 7.3b

(Right) The same data set cropped with a longitudinal plane passing through the aortic valve and the center on the mitral valve (AVI 6643 kb)

Video 7.4

Full-volume, multibeat 3DE transthoracic acquisition to visualize the mitral valve from the ventricular perspective (AVI 5384 kb)

Video 7.5

Triplane acquisition of the regurgitant jet of a mitral valve from a single cardiac beat to visualize both the direction and extension of the jet in the left atrium, and to measure the size of the vena contracta (AVI 3973 kb)

Video 7.6

Full volume 3DE data set of the left ventricle obtained with transthoracic echocardiography and cropped in a longitudinal axis to visualize both papillary muscles (AVI 7009 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sorina Mihaila Baldea
    • 1
    • 2
  • Dragos Vinereanu
    • 1
    • 2
  • Roberto M. Lang
    • 3
  1. 1.The University of Medicine and Pharmacy “Carol Davila”BucharestRomania
  2. 2.Department of CardiologyEmergency University Hospital BucharestBucharestRomania
  3. 3.Noninvasive Cardiac Imaging Laboratories, Department of Medicine/Section of CardiologyUniversity of Chicago Medical CenterChicagoUSA

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