Additional View of the Mitral Valve

Abstract

Lambert et al. (1) published their systematic evaluation of the mitral valve by transesophageal echocardiography. We use a comparable approach to assess the mitral valve in patients scheduled for elective coronary artery bypass surgery with one additional imaging view, which allows the evaluation of the chordae tendineae. By rotating the transducer to 90° starting from a midshort-axis view in a transgastric position, a two-chamber view is produced. At the top of the screen, the posterior wall with the posteromedial papillary muscle is visualized and at the bottom of the screen, the anterior wall with the anterolateral papillary muscle can be seen (Figs. 1 and 2). Minimal probe movements allow accurate assessment of the chordae tendineae and their insertion at the margins of the mitral valve leaflets. Distinction can be made between the chordae from the posteromedial papillary muscle inserting on the medial and middle scallops of the posterior leaflet and those inserting on the medial and middle thirds of the anterior leaflet. Also distinction can be made between the chordae from the anterolateral papillary muscle inserting on the lateral and middle scallops of the posterior leaflet and those inserting on the lateral and middle thirds of the anterior leaflet (2).Figure 1: Visualization of the mitral valve seen from the left atrium. MVPL = mitral valve posterior leaflet, MVAL = mitral valve anterior leaflet, PPM AL = anterolateral papillary muscle, PPM PM = posteromedial papillary muscle, ALC = anterolateral commisure, PMC = posteromedial commisure.Figure 2: Short axis view at 90°. LV = left ventricle, LA = left atrium, CT = chordae tendineae, LVPW = left ventricular posterior wall, LVAW = left ventricular anterior wall, PPM AL = anterolateral papillary muscle, PPM PM = posteromedial papillary muscle, MVPL = mitral valve posterior leaflet, MVAL = mitral valve anterior leaflet.Gert Poortmans MD* Guido Schüpfer MBA, HSG‡ Carl Roosens MD*† J. Poelaert MD, PhD*†