Histological appearance of anomalous anterior papillary muscle

Živković, Vladimir; Glumac, Sofija; Damjanjuk, Irina; Nikolić, Slobodan

doi:10.1007/s12024-014-9653-5

Cited by 1 publication

(5 citation statements)

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“…Histology of anomalous papillary muscle insertion was performed in four cases, two of which were already reported [13]. We observed the pattern of direct insertion of cardiomyocytes into the thick fibrous tissue of the leaflet, with a narrow zone of overlapping, without the interposition of loose connective tissue (Figure 4).…”

Section: Re Sultsmentioning

confidence: 85%

“…These can contribute to the development of systolic anterior motion (SAM) of the mitral valve when the aortal mitral valve leaflet is pulled into the LVOT in early systole [27, 28]. In addition to exaggerating LVOT obstruction by SAM, mitral regurgitation and/or stenosis usually exist here [13]. All these processes could predispose subjects to life‐threatening arrhythmias and sudden cardiac death [10, 29, 30].…”

Section: Discussionmentioning

confidence: 99%

“…The usual loose connective tissue between the middle portion of the leaflet and endothelium [21] was absent on the ventricular surface of the leaflet but unremarkable on the atrial side of the leaflet (Figure 4). We did not perform special staining techniques, but two already reported cases demonstrated hypocellular, partially hyalinized connective tissue with muscle fibers throughout the cephalad portion with Masson's trichrome stain [13].…”

Section: Discussionmentioning

confidence: 99%

“…The authors incidentally identified four cases of anomalous anterior papillary muscle insertions into the mitral valve leaflet between 2007 and 2014 [10,13]. Afterward, one of the authors of this article examined the mitral valve apparatus from the atrial and ventricular side to actively identify the anomalous papillary muscle insertion in the autopsies he performed from January 2015 to March 2022.…”

Section: Re Sultsmentioning

confidence: 99%

“…Due to the dynamic LVOT obstruction by anomalous papillary muscle insertion, diverse anatomy of normal papillary muscles, and possible lack of awareness of this entity by forensic pathologists, the significance of this pathology might be overlooked, and its prevalence, especially in apparently healthy subjects, might be underreported. There is a paucity of forensic autopsy studies of anomalous papillary muscles [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Anomalous papillary muscle insertion into mitral valve leaflet: Autopsy study and implications

Leković

Živković

Nikolić

2022

Journal of Forensic Sciences

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Anomalous papillary muscle (APM) insertion into the anterior mitral valve leaflet is often associated with hypertrophic cardiomyopathy (HCM) but is reported in other cases as a rare finding. Mere presence does not strictly imply hemodynamic disturbance, and several types exist, with various impacts on left ventricular outflow tract (LVOT) obstruction. The interpretation of isolated anomaly is challenging at autopsy because significant LVOT obstruction is dynamic. We analyzed autopsy cases with APM regarding the site of PM insertion and origin, number of PM bellies, anomalous insertions, heart weight, left ventricle (LV) thickness, LV endocardial fibrosis, subjects' age, sex, cause, and manner of death. A total of 20 cases were identified. Fourteen were identified incidentally, while in 670 systematically examined hearts, the APM was identified in six cases, indicating a prevalence of 0.9%. In eight cases, the manner of death was natural (one case with HCM), and in 12 non-natural. Type II anomaly of PM was most frequent (n = 8), followed by Type III (n = 7) and Type I (n = 5). Subjects who died of natural causes were significantly older and had heavier hearts (median 455 g vs. 330 g; p < 0.05) without difference in LV thickness (median 16 mm vs. 15 mm; p > 0.05). Histology performed in four cases showed a pattern of direct insertion of cardiomyocytes into the leaflet's thick fibrous tissue with a narrow overlapping zone.The APM is rare, can be easily overlooked, and does not imply significant pathology per se. We discussed proper assessment of the significance of this anomaly at autopsy.

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Section: Re Sultsmentioning

confidence: 85%