Surgical anatomy of the mitral valve leaflets

SURGICAL ANATOMY OF THE MITRAL VALVE LEAFLETS (Abstract): The mitral valve is a complex three-dimensional structure and mitral valve repair is the therapeutic intervention of choice in patients with significant mitral regurgitation due to lower rates of mortality and reoperation, lower incidence of heart failure, infective endocarditis and atrial fibrillation compared to valve replacement. The aim of the present study is to review the classical concepts regarding the anatomy of mitral valve leaflets and to analyze their morphology related to current clinical and surgical practices. The authors analyzed intraoperatively the mitral valves of 45 patients that benefited from mitral valve repair between 2002-2014 at the Cardiovascular Diseases Institute from Iasi, Romania. The mean age was 60.09±13.68 years and the indication for surgery was established for mitral regurgitation in all cases. From a morphological point of view, two commissures separating anterior and posterior leaflets were observed in all cases. Standard clefts described by Carpentier as separating P1 from P2 scallops and P2 from P3 scallops were inconstant and noted in 30 cases (P1-P2 cleft) and 34 cases respectively (P2-P3 cleft).. In 40 cases, additional clefts were noted inside conventional Carpentier scallops. Morphometrically, the A2 scallop measured 25.31±2.54 mm, the anterior leaflet height was of 36.12±4.73 mm and the intercommissural length 35.63 ± 5.18 mm. An accurate in vivo evaluation of the mitral valve and a common nomenclature are mandatory to mitral valve surgery as confusions, anatomical variants and incomplete knowledge of the morphology and structure of mitral apparatus could interfere the result of surgical intervention.