Mitral Valve

Question 1

Draw the Anatomical View of the Mitral Valve

Answer 1

Question 2

Compare the Anterior and Posterior Leaflets of the MV in terms of attachment to annulus and surface area

Answer 2

Posterior: thinner, stretches around the back (double the attachment to the annulus, but only half the base to tip length)
Anterior: wider, but with less attachment to the annulus
Both leaflets have the same surface area

Question 3

Describe the Copation of the MV and what is the best TOE view to visualise it?

Answer 3

The coaptation line is curved and at the level of the annulus or slightly below

There is 0.8 cm- 1 cm leaflet overlap (coaptation) at end-systole

Mid Commissural View (30 degrees)

ME LAX:
- perpendicular to the coaptation line (good for leaflet length measurement)
- aligned with the short higher axis (AP) (P2/A2)

Question 4

How is the MV situated in relation to the AV?

Answer 4

The anterior mitral leaflet is closest to the AV
It is in fibrous continuity with the NCC and the LCC of the AV

The posterior leaflet was three distinct scallops (none on the anterior), which pleat to shorten the length for closure

Question 5

Draw the Carpentier labelling of the MV and how they are attached to the Pap Muscles

Answer 5

Question 6

How do the primary and secondary chordae attach to the Pap Muscles?

Answer 6

The primary chordae attach to the free edges of the leaflets (if these rupture -> acute MR)

The secondary chordae attach to the underside of the leaflets

If these thicken/fuse -> Mitral Stenosis in the form of a subvalvular obstruction

Question 7

What is the LAX view best for measuring in terms of the MV?

Answer 7

1. AP annular dimension (P2/A2)
2. P2/A2 coaptation
3. Vena Contracta Width

Question 8

Discuss the process of 3D imaging of MV

Answer 8