Mitral Anatomy

Question 1

Which valve is more apically positioned; the mitral or tricuspid valve?

Answer 1

The tricuspid valve.

Question 2

The anterior leaflet attaches to how much of the annulus, compared to the posterior leaflet?

Answer 2

Anterior = 1/3rd; Posterior = 2/3rd’s.

Question 3

Which leaflet is larger, the anterior or posterior?

Answer 3

The anterior (only marginally); the anterior leaflet is longer than the posterior leaflet which means their surface areas are similar.

Question 4

Each of the mitral valve leaflets are split into six scallops (A1, A2, A3 & P1, P2, P3). Which leaflet is only artificially divided?

Answer 4

The anterior leaflet.

Question 5

Which of the scallops is the most lateral, and which of the scallops is the most medial?

Answer 5

Scallop 1 is the most lateral. Scallop 3 is the most medial.

Question 6

What are the three types of Chordae Tendineae?

Answer 6

Primary/first order/marginal chordae | Secondary/second order/strut chordae | Tertiary/third order/basal chordae.

Question 7

The primary/first order/marginal chordae attach where?

Answer 7

Onto the free edge of the leaflets.

Question 8

The secondary/second order/strut chordae attach where?

Answer 8

Onto the ventricular surface of the leaflets (beyond the free edge).

Question 9

The tertiary/third order/basal chordae attach where?

Answer 9

To the base of the posterior leaflet only.

Question 10

Where do tertiary/third order/basal chordae arise from?

Answer 10

The ventricular wall.

Question 11

The posteromedial papillary muscle is typically perfused by which artery?

Answer 11

The right coronary artery.

Question 12

Why is the anterolateral papillary muscle less susceptible to ischaemic injury?

Answer 12

It has dual blood supply.

Question 13

The pLAX view shows which scallops of the mitral valve leaflets?

Answer 13

The middle segments (A2 & P2).

Question 14

The pSAX view shows which scallops of the mitral valve leaflets?

Answer 14

The entire leaflets are displayed in a medial-lateral orientation from left to right.

Question 15

The apical 4-chamber view shows which scallops of the mitral valve leaflets?

Answer 15

Typically A3, A2 and P1.

Question 16

The apical 2-chamber view shows which scallops of the mitral valve leaflets?

Answer 16

A2 and a portion of the P3 and P1 scallops.

Question 17

The apical 3-chamber view shows which scallops of the mitral valve leaflets?

Answer 17

Similar to the pLAX view; the middle segments (A2 & P2).

Question 18

Which view primarily shows the anterior leaflet, meaning abnormalities of the posterior leaflet will not be readily evident?

Answer 18

The apical 2-chamber view.

Question 19

What are the five components of the MV apparatus?

Answer 19

The mitral annulus, leaflets, chordae tendineae, papillary muscles and the underlying ventricular walls.

Question 20

Describe the mitral valve annulus.

Answer 20

It is a D-shaped fibromuscular ring and is saddle-shaped (alike a pringle).

Question 21

Name the two mitral valve leaflets.

Answer 21

Anterior and Posterior.

Question 22

The anterior MVL is in fibrous continuity with what?

Answer 22

The aortic valve.

Question 23

The two commissures and papillary muscles are named what?

Answer 23

The anterolateral and posteromedial commissures/papillary muscles.

Question 24

True or false; both papillary muscles provide chordae to portions of both leaflets.

Answer 24

True.

Question 25

In the pLAX view, by tilting the probe towards the RV inflow view, what MV leaflet scallops can be visualised.

Answer 25

A3 and P3.

Question 26

In the pLAX view, by tilting the probe towards the RV outflow view, what MV leaflet scallops can be visualised.

Answer 26

A1 and P1.