Abstract
The atrioventricular heart valves (AHVs) are responsible for directing unidirectional blood flow through the heart by properly opening and closing the valve leaflets, which are supported in their function by the chordae tendineae and the papillary muscles. Specifically, the chordae tendineae are critical to distributing forces during systolic closure from the leaflets to the papillary muscles, preventing leaflet prolapse and consequent regurgitation. Current therapies for chordae failure have issues of disease recurrence or suboptimal treatment outcomes. To improve those therapies, researchers have sought to better understand the mechanics and microstructure of the chordae tendineae of the AHVs. The intricate structures of the chordae tendineae have become of increasing interest in recent literature, and there are several key findings that have not been comprehensively summarized in one review. Therefore, in this review paper, we will provide a summary of the current state of biomechanical and microstructural characterizations of the chordae tendineae, and also discuss perspectives for future studies that will aid in a better understanding of the tissue mechanics–microstructure linking of the AHVs’ chordae tendineae, and thereby improve the therapeutics for heart valve diseases caused by chordae failures.
Highlights
The atrioventricular heart valves (AHVs) regulate the unidirectional flow of blood through the heart chambers by the cyclic opening and closing of soft tissue leaflets. These leaflets are supported in their functions by the chordae tendineae, which attach to the papillary muscles
The chordae tendineae can be 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)
We found in our previous study an average of 30 chordae in porcine mitral valve (MV) and 35 chordae in the porcine tricuspid valve (TV), and an average of 15 and 24 chordae in ovine MV and TV, respectively [24]
Summary
The atrioventricular heart valves (AHVs) regulate the unidirectional flow of blood through the heart chambers by the cyclic opening and closing of soft tissue leaflets. These leaflets are supported in their functions by the chordae tendineae, which attach to the papillary muscles. Khoiy et al (2018) used an in vitro valve apparatus to observe changes in the tricuspid valve closure after induced chordae rupture, and found that ruptured chordae caused up to an 8.8% dilation of the annulus and consequent regurgitation [6] In another in vitro study for the mitral valve, it was found that a significantly lower ventricular pressure was required to cause leaflet prolapse caused by chordae rupture [7]. We will give some commentary remarks regarding the state of the art of research and perspective for future studies that would be beneficial to further the chordae biomechanics research field
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