Mitral valve posterior leaflet morphology revisited from pathological anatomy to three-dimensional echocardiography evaluation: implications in patients with myxomatous disease for surgical procedures

The perfect function of the mitral valve is linked to the anatomical conformation and physiological interaction of all the component of the mitral valve complex (leaflets, annulus, chordae, papillary muscles, left ventricle). The most important component of the valve are the leaflets. The nomenclature and the number of the leaflets are divergent in different studies. Usually the clinical Carpentier’s Classification is used, which identifies three posterior leaflet scallops: from antero-lateral (P1) to central (P2) and postero-medial (P3). The terminology of mitral valve leaflet is a lot debated in the scientific literature. The aim of the study is to analyze the variability of the anatomy of posterior leaflet in normal subjects (Autoptic and cardiectomy specimens) and patients with myxomatous disease (three dimensional echocardiography) for assess possible difference and similarity. In patient with myxomatous disease we evaluate the clinical influence of the anatomy of the posterior leaflet on the planning of the mitral valve surgical repair strategy. MATERIALS AND METHODS Thirty normal heart specimens without mitral valve disease, were examined by three independent observers ( two pathologists and 1 cardiologist). The specimens which had been fixed in formalin following autopsy or cardiectomy, were selected in the anatomo-pathological heart collection of Padua University. The mitral valve was opened along the optus margin of the heart and evaluated. It was used a new terminology and call the normal physiological indentation, deep more than 50% of the leaflet high, “subcommisure” and the simple indentation ,deep less than 50% ,“incisure”. The subcommissure and incisure with relative chordae tendineae were studied in detail. Special attention was given to (1) the number of the scallops of posterior leaflet with (2) the characterization of the subcommisure and incisure, to (3) the high and the width of every single scallop, and to (4) to the high of the leaflet in correspondence of subcommisure, incisure and ...