Mitral leaflet anatomy revisited

Jason L. Quill, Alexander J. Hill, Timothy G. Laske, Ottavio Alfieri, Paul A. Iaizzo

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


Objective: The aims of this work were to employ functional imaging capabilities of the Visible Heart laboratory and endoscopic visualization of mitral valves in perfusion-fixed specimens to better characterize variability in mitral valve leaflet anatomy and to provide a method to classify mitral leaflets that varies from the current nomenclature. Methods: We gathered functional endoscopic video footage (11 isolated reanimated human hearts) and static endoscopic anatomical images (38 perfusion-fixed specimens) of mitral leaflets. Commissure and cleft locations were charted using Carpentier's accepted description. Results: All hearts had 2 commissures separating anterior and posterior leaflets. "Standard" clefts separating P1/P2 were found in 66% of hearts (n = 25), and standard clefts separating P2/P3 were present in 71% of hearts (n = 27). "Deviant" clefts occurred in each region of the anterior leaflet (A1, A2, A3), and their relative occurrences were 5%, 8%, and 13% (n = 2, 3, 5), respectively. Deviant clefts were found in posterior leaflets: 13.2% in P1 (n = 5), 32% in P2 (n = 12), and 21% in P3 (n = 8). Conclusions: Humans elicit complex and highly variable mitral valve anatomy. We suggest a complementary, yet simple nomenclature to address variation in mitral valve anatomy by describing clefts as either standard or deviant and locating regions in which they occur (A1 to A3 or P1 to P3).

Original languageEnglish (US)
Pages (from-to)1077-1081
Number of pages5
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number5
StatePublished - May 2009

Bibliographical note

Funding Information:
This work was supported in part by the Institute for Engineering in Medicine at the University of Minnesota and by Medtronic, Inc.

Copyright 2009 Elsevier B.V., All rights reserved.


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