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INTERESTING CARDIOTHORACIC IMAGE Table of Contents   
Year : 2007  |  Volume : 10  |  Issue : 1  |  Page : 63
Choardae tendineae from posteromedial papillary muscle inserting into the anterior mitral leaflet - an unusual presentation


Department of Anaesthesiology and Intensive Care, and Cardiothoracic Surgery, G.B. Pant Hospital, New Delhi., India

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How to cite this article:
Tempe DK, Datt V, Banerjee A, Gandhi A. Choardae tendineae from posteromedial papillary muscle inserting into the anterior mitral leaflet - an unusual presentation. Ann Card Anaesth 2007;10:63

How to cite this URL:
Tempe DK, Datt V, Banerjee A, Gandhi A. Choardae tendineae from posteromedial papillary muscle inserting into the anterior mitral leaflet - an unusual presentation. Ann Card Anaesth [serial online] 2007 [cited 2019 Jul 22];10:63. Available from: http://www.annals.in/text.asp?2007/10/1/63/37929


A 40-years-male with mitral stenosis, mitral regurgitation, aortic stenosis and aortic regurgitation was undergoing mitral and aortic valve replacement. During routine intraoperative transoesophageal echocardiography (TOE), it was observed that there were two heads of postero­medial papillary muscle (PPM) and a chordae tendineae originating from one of them was inserting into the anterior mitral leaflet (AML, [Figure 1] and [Figure 2]).

Usually the antero-lateral papillary muscle consists of a single large trunk, whereas the PPM can have one to three heads. [1] From each papillary muscle head chordae tendinae originate and insert into the corresponding half of the mitral leaflet. [2] However few reports have described that chordate from PPM can insert into AML. Lam et al [3] examined the autopsy specimens of 50 normal hearts and reported that chordae in 2 hearts originated from PPM and inserted into the AML. Rusted et al have also pointed out that the chordae originating from PPM can insert into the apex of AML with an average length of 2.2 cm in men and 1.8 cm in women. The present patient also shows two heads of PPM and chordae from one of them inserting into AML. Since the two heads of the PPM were not visible in the conventional TOE views (e.g. transgastric midpapillary view at 0o ), modified proximal transgastric views have been shown.

 
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1.Plessis DU, Marchand LA. The anatomy of the mitral valve and associated structures. Thorax 1964; 19: 221-227  Back to cited text no. 1    
2.Rusted IE, Scheifley CH, Edward JE. Studies of mitral valve and associated structures. Circulation 1952; 6: 825­831.  Back to cited text no. 2    
3.Lam JHC, Ranganathan N, Wigle ED, Silver MD. Morphology of the human mitral valve. 1. Chordae tendineae; A new classification. Circulation 1970; 41: 449.  Back to cited text no. 3    

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Correspondence Address:
Deepak K Tempe
Department of Anaesthesiology and Intensive Care, G.B. Pant Hospital New Delhi. 110002.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.37929

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1 Chordae tendineae from posteromedial papillary muscle inserting into the anterior mitral leaflet--an unusual presentation. What is unusual?
Goel, S.
Annals of cardiac anaesthesia. 2007; 10(2): 156
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