Anatomy of the Mitral Apparatus

  • Francesca Indorato
  • Silvio Gianluca Cosentino
  • Giovanni Bartoloni


The mitral valve is part of the left ventricular outflow tract and of the aortic root; it facilitates the accommodation of blood, eventually followed by its rapid, efficient, and forceful ejection through the left ventricular outflow tract into the aortic root.

The mitral valve apparatus and the left ventricle are so interdependent that there is no mitral valve defect that does not affect the left ventricle in some way, and, in turn, there is no morphological or functional alteration of the left ventricle that has no consequence, to a greater or lesser extent, for the mitral valve. Therefore, the mitral valve is not a passive structure that moves solely as a result of the forces generated by cardiac activity, but rather a structure with its own sphincteric activity concentrated mainly in the annulus, which contributes to the ventricle’s contractility and, in turn, is heavily affected by it.

The mitral valve apparatus comprises the annulus and portion of myocardium located above and below it, the leaflets, the chordae tendineae, and the papillary muscles.


  1. 1.
    Di Mauro M, Gallina S, D’Amico MA, et al. Functional mitral regurgitation: from normal to pathological anatomy of mitral valve. Int J Cardiol. 2013;163:242–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Muresian H. The clinical anatomy of the mitral valve. Clin Anat. 2009;22:85–98.CrossRefPubMedGoogle Scholar
  3. 3.
    Pollick C, Pittman M, Filly K, Fitzgerald PJ, Popp RL. Mitral and aortic valve orifice area in normal subjects and in patients with congestive cardiomyopathy: determination by two dimensional echocardiography. Am J Cardiol. 1982;49:1191–6.CrossRefPubMedGoogle Scholar
  4. 4.
    van Rijk-Zwikker GL, Delemarre BJ, Huysmans HA. Mitral valve anatomy and morphology: relevance to mitral valve replacement and reconstruction. J Card Surg. 1994;9(2 Suppl):255–61.CrossRefPubMedGoogle Scholar
  5. 5.
    Silverman ME, Hurst JW. The mitral complex: interaction of the anatomy, physiology, and pathology of the mitral annulus, mitral valve leaflets, chordae tendineae, and papillary muscles. Am Heart J. 1968;76:399.CrossRefPubMedGoogle Scholar
  6. 6.
    Tsakiris AG, Von Bernuth G, Rastelli GC, et al. Size and motion of the mitral valve annulus in anesthetized intact dogs. J Appl Physiol. 1971;30:611.CrossRefPubMedGoogle Scholar
  7. 7.
    Ormiston JA, Shah PM, Tei C, et al. Size and motion of the mitral valve annulus in man. I. A two-dimensional echocardiographic method and findings in normal subjects. Circulation. 1981;64:113.CrossRefPubMedGoogle Scholar
  8. 8.
    Tsakiris AG, Sturm RE, Wood EH. Experimental studies on the mechanisms of closure of cardiac valves with use of roentgen videodensitometry. Am J Cardiol. 1973;32:136–43.CrossRefPubMedGoogle Scholar
  9. 9.
    Davis PK, Kinmonth JB. The movements of the annulus of the mitral valve. J Cardiovasc Surg. 1963;4:427–31.Google Scholar
  10. 10.
    Keren G, Sonnenblick EH, LeJemtel TH. Mitral annulus motion. Relation to pulmonary venous and transmitral flows in normal subjects and in patients with dilated cardiomyopathy. Circulation. 1988;78:621–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Toumanidis ST, Sideris DA, Papamichael CM, et al. The role of mitral annulus motion in left ventricular function. Acta Cardiol. 1992;47:331.PubMedGoogle Scholar
  12. 12.
    Choure AJ, Garcia MJ, Hesse B, et al. In vivo analysis of the anatomical relationship of coronary sinus to mitral annulus and left circumflex coronary artery using cardiac multidetector computed tomography: implications for percutaneous coronary sinus mitral annuloplasty. J Am Coll Cardiol. 2006;48:1938–45.CrossRefPubMedGoogle Scholar
  13. 13.
    Cook AC, Anderson RH. Attitudinally correct nomenclature. Heart. 2002;87:503–6.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    van Gils FA. The fibrous skeleton in the human heart: embryological and pathogenetic considerations. Virchows Arch A Pathol Anat Histol. 1981;393:61.CrossRefPubMedGoogle Scholar
  15. 15.
    Davila JC, Palmer TE. The mitral valve: anatomy and pathology for the surgeon. Arch Surg. 1962;84:174.CrossRefPubMedGoogle Scholar
  16. 16.
    Perloff JK, Roberts WC. The mitral apparatus: functional anatomy of mitral regurgitation. Circulation. 1972;46:227.CrossRefPubMedGoogle Scholar
  17. 17.
    Fenoglio J Jr, Tuan DP, Wit AL, et al. Canine mitral complex: ultrastructure and electromechanical properties. Circ Res. 1972;31:417.CrossRefPubMedGoogle Scholar
  18. 18.
    Walmsley R. Anatomy of human mitral valve in adult cadaver and comparative anatomy of the valve. Br Heart J. 1978;40:35.CrossRefGoogle Scholar
  19. 19.
    Anderson RH, Wilcox BR. The anatomy of the mitral valve. In: Wells FC, Shapiro LM, editors. Mitral valve disease. Oxford: Butterworth-Heinemann; 1996.Google Scholar
  20. 20.
    Fenster MS, Feldman MD. Mitral regurgitation: an overview. Curr Probl Cardiol. 1995;20:193.CrossRefPubMedGoogle Scholar
  21. 21.
    Timek TA, Green GR, Tibayan FA, et al. Aorto-mitral annular dynamics. Ann Thorac Surg. 2003;76:1944–50.CrossRefPubMedGoogle Scholar
  22. 22.
    Karlsson MO, Glasson JR, Bolger AF, Daughters GT, Komeda M, Foppiano LE, Miller DC, Ingels NB Jr. Mitral valve opening in the ovine heart. Am J Physiol. 1998;274:H552–63.PubMedGoogle Scholar
  23. 23.
    Levine RA, Triulzi MO, Harrigan P, Weyman AE. The relationship of mitral annular shape to the diagnosis of mitral valve prolapse. Circulation. 1987;75:756.CrossRefPubMedGoogle Scholar
  24. 24.
    Sovak M, Lynch PR, Stewart GH. Movement of the mitral valve and its correlation with the first heart sound: selective valvular visualization and high-speed cineradiography in intact dogs. Invest Radiol. 1973;8:150–5.CrossRefPubMedGoogle Scholar
  25. 25.
    Pohost GM, Dinsmore RE, Rubenstein JJ, et al. The echocardiogram of the anterior leaflet of the mitral valve: correlation with hemodynamic and cineroentgenographic studies in dogs. Circulation. 1975;51:88–97.CrossRefPubMedGoogle Scholar
  26. 26.
    Tsakiris AG, Gordon DA, Mathieu Y, et al. Motion of both mitral valve leaflets: a cineroentgenographic study in intact dogs. J Appl Physiol. 1975;39:359–66.CrossRefPubMedGoogle Scholar
  27. 27.
    Luther RR, Meyers SN. Acute mitral insufficiency secondary to ruptured chordae tendineae. Arch Intern Med. 1974;134:568.CrossRefPubMedGoogle Scholar
  28. 28.
    Voci P, Bilotta F, Caretta Q, Mercanti C, Marino B. Papillary muscle perfusion pattern. A hypothesis for ischemic papillary muscle dysfunction. Circulation. 1995;91:1714–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Armour JA, Randall WC. Electrical and mechanical activity of papillary muscle. Am J Physiol. 1970;218:1710–7.PubMedGoogle Scholar
  30. 30.
    Cronin R, Armour JA, Randall WC. Function of the in-situ papillary muscle in the canine left ventricle. Circ Res. 1969;25:67–75.CrossRefPubMedGoogle Scholar
  31. 31.
    Lam JH, Ranganathan N, Wigle ED, Silver MD. Morphology of the human mitral valve. I. Chordae tendineae: a new classification. Circulation. 1970;41:449–58.CrossRefPubMedGoogle Scholar
  32. 32.
    Marzilli M, Sabbah HN, Lee T, Stein PD. Role of the papillary muscle in opening and closure of the mitral valve. Am J Physiol. 1980;238:H348–54.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Francesca Indorato
    • 1
  • Silvio Gianluca Cosentino
    • 2
  • Giovanni Bartoloni
    • 3
  1. 1.Postgraduate School of Legal MedicineUniversity of CataniaCataniaItaly
  2. 2.University of CataniaCataniaItaly
  3. 3.Professor of Anatomic Pathology - Postgraduate School of CardiologyUniversity of CataniaCataniaItaly

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