CHAPTER 32 ANTERIOR LEAFLET PERFUSION 32-1
MITRAL VALVE MECHANICS by Neil B. Ingels, Jr. and Matts Karlsson
CHAPTER 32 ANTERIOR LEAFLET PERFUSION
The anterior leaflet contains both sensory and motor nerves, striated and smooth muscle, VICs, and other metabolizing cell types, thus it is not surprising that blood vessels have been found in the leaflet body and chordae, although such findings have sometimes stirred controversy. Swanson et al.1 employed selective injections of fluorescein dye into the left anterior descending and circumflex coronary arteries of ovine hearts excised immediately after heparinization and cardioplegic arrest to assess potential leaflet perfusion patterns associated with such vessels.
Figure 32.1, a typical finding from the study of Swanson et al.1, shows vessels extending and branching into the leaflet from regions near the anterior commissure. Figure 32.2 shows endocardial vessels leading up to chordae as one potential source of such perfusion.
From these studies, Swanson et al.1 concluded that the myocyte-containing annular half of the anterior leaflet had a rich vascular supply arising from the mid- and distal left circumflex coronary artery, entering the leaflet near the trigones, particularly near the commissures. Additional leaflet perfusion may also be provided by both strut and, possibly, edge chordae.
1 Swanson JC, Davis LR, Arata K, Briones EP, Bothe W, Itoh A, Ingels NB, Miller DC. Characterization of mitral valve anterior leaflet perfusion patterns. J Heart Valve Dis. 2009;18(5):488-495.
Figure 32.1. A prominent vessel extending down into the leaflet near the anterior commissure.
CHAPTER 32 ANTERIOR LEAFLET PERFUSION 32-2
MITRAL VALVE MECHANICS by Neil B. Ingels, Jr. and Matts Karlsson
