Morphological Study of Chordae Tendinae in Human Cadaveric Hearts

Abstract

Objectives:The chordae tendinae (CT) are strong, fibrous connections between the valve leaflets and the papillary muscles. Dysfunction of the papillary muscles and chordae is frequent. Mitral valve replacement with preservation of CT and papillary muscles may preserve postoperative left ventricular function better than conventional mitral valve replacement in patients with chronic mitral regurgitation.Methods:The study was carried out on 116 human cadaveric hearts. The heart was opened through the atrioventricular valve to view the constituents of the complex. Origin, attachments, insertions, distribution, branching pattern and gross structure of CT were observed and studied in detail.Results:In the present study more than 21 terminologies of CT were defined by classifying it into six different types. Classification is done according to the origin, attachments, insertion, distribution, branching pattern and gross structure. Terminologies defined are as follows. Apical pillar chordae, Basal pillar chordae, True chordae, False chordae, Interpillar chordae, Pillar wall chordae, Cusp chordae, Cleft chordae, Commissural chordae, First order chordae, Second order chordae, Free zone chordae, Marginal chordae, Rough zone chordae, Straight chordae, Branched-fan shaped chordae, Spiral chordae, Irregular-web chordae, Tendinous chordae, Muscular chordae, Membranous chordae. Basal pillar chordae are found in 9.48%. Mean number of chordae taking origin from apical half of a single papillary muscle or single head of papillary muscle was 9.09 with the range of 3-18. Mean number of the marginal chordae attached to a single cusp was 22.63 ranging from 11 to 35. Strut chordae showed interesting insertion with broad aponeurosis in 38.79% and large muscular flaps in 13.79%. Chordae muscularis were found in 14% and membranous chordae were found in 6%.Conclusions:This knowledge may prove useful for cardiologists and cardiac surgeons.

Study of the normal heart size in Northwest part of Iranian population: a cadaveric study

“…The chordae tendineae ranges between 1 and 10 in Brazil, 3 and 22 in Indian cadavers, 24 and 4 and 35 in the present study.…”

Mechanics and Microstructure of the Atrioventricular Heart Valve Chordae Tendineae: A Review

“…Chordae attaching to the leaflets are considered as true chordae, while those attaching elsewhere, such as the ventricular wall, are considered false chordae [17]. For this review, the focus will be on the true chordae, and any discussions henceforth are to be considered as referring to true chordae tendineae.…”

“…For this review, the focus will be on the true chordae, and any discussions henceforth are to be considered as referring to true chordae tendineae. Generally, chordae originate from the papillary muscle as a singular strand, which then either remains straight or branches into fan shapes prior to a leaflet insertion [17]. The chordae tendineae can be more specifically classified based on their respective insertion region to the leaflet: basal chordae attaching to the leaflet base; marginal chordae attaching to the leaflet free edge; and the notably-thicker strut chordae anchoring at the central belly region of the AHV leaflet ( Figure 1a).…”

Numerical modeling of transapical mitral valve repair

“…Starting from the PMs, from which they originate, a single main branch can be identified, subdivided into two or more secondary chordae, which have a large number of branches. The chordae attached to the commissural sections are called commissural chordae, whereas the chordae inserted into the leaflets are referred to as the leaflet chordae (Gunnal et al 2015). Based on their insertion point, the leaflet chordae can be divided into two categories:…”

“…Second order or basal chordae are inserted into the ventricular surface of the leaflets closer to the annulus (Degandt et al 2007). Among these, four chordae (two inserted into the AL, and two into the PL) are particularly thick and strong, named as strut chordae (Gunnal et al 2015). There are two PMs arising from the LV wall, each having one or multiple heads with the chordae attached (Madu and D'Cruz 1997).…”