Anatomy of the Heart Valves

Question 1

Which part of the heart is most posterior?

Answer 1

The left atrium.

Question 2

Which vertebrae are beneath the posterior heart when lying supine?

Answer 2

T5-T8

Question 3

how much of the heart lies to the left of the spine?

Answer 3

2/3rds

Question 4

What forms the superior border of the heart?

Answer 4

The superior edge of the RA where the SVC enters, the origin of the ascending aorta and pulmonary trunk, and the inferior edge of the LAA.

Question 5

What forms the right border of the heart?

Answer 5

The lateral edge of the Right Atrium from the entry of the SVC down to the entry of the IVC.

Question 6

What forms the inferior border of the heart?

Answer 6

The inferior edge of the RV, the inferior edge of the interventricular septum, and the portion of the LV that includes the apex of the heart.

Question 7

What forms the left border of the heart?

Answer 7

The lateral edge of the LV from the apex of the heart up to the lateral edge of the LAA.

Question 8

What composes the anterior (sternocostal) surface of the heart?

Answer 8

Mainly the RV from the pulmonary trunk to the apex, also the interventricular groove and the part of the LV that is proximal to this.

Question 9

What makes up the Right Pulmonary Surface of the heart?
What part of the body does this surface appose?

Answer 9

The exterior surface of the RA and the RAA.
This surface apposes the right lung.

Question 10

What makes up the inferior (diaphragmatic) surface of the heart?

Answer 10

The LV posterior surface, the posterior interventricular groove, and the RV posterior surface.

Question 11

What makes up the base surface of the heart?

Answer 11

The posterior surface of the LA. The posterior surface of the RA up to the lateral border of the IVC/SVC entrances. The superior border of the base surface is the bifurcation of the pulmonary artery. The inferior border is the Coronary Sinus.

Question 12

What makes up the left pulmonary surface?
What does this surface of the heart appose?

Answer 12

The left lateral surface of the LV.
This surface apposes the left lung.

Question 13

Where is the acute margin of the heart?

Answer 13

The connecting border between the anterior (sternocostal) and inferior (diaphragmatic) surfaces of the heart.

Question 14

Where is the obtuse margin of the heart?

Answer 14

The border between the anterior (sternocostal) and right pulmonary (left) surfaces.

Question 15

• What is the name of the highlighted area of the heart?
• What is it’s function?

Answer 15

• Infundibulum (conus arteriosus)
• It acts as a support structure for the pulmonary valve

Question 16

label the following structures around the mitral valve

Answer 16

• Coronary sinus
• Anterolateral trigone
• Posteromedial trigone
• Circumflex artery
• Aortomitral curtain
• Bundle of His
• Posteromedial trigone
• Noncoronary sinus
• Left coronary sinus

Question 17

Label the sections of the mitral valve leaflets acording to Duran and Carpentier/ASE nomenclature.

Answer 17

Question 18

Which parts of the mitral valve annulus are strongest?

Answer 18

The right and left trigones.

Question 19

What changes occur to the mitral valve during systole?

Answer 19

• The mitral valve orifice reduces size by up to 40%, changing shape from circular to crescentic with the base of the anterior leaflet remaining constant.
• The whole valve moves anteriorly and to the left.

Question 20

Describe the number of mitral valve leaflets and their thickness.

Answer 20

There is an anterior and posterior leaflet with two small commisural leaflets at the joins between them.
Each leaflet is less than 3mm thick.

Question 21

how much of the mitral opening is filled by the anterior valve leaflet?

Answer 21

One third

Question 22

What are the different zones of the mitral valve anterior leaflet?

Answer 22

• Rough zone: Thicker and has chordae tendineae insertions. Appears opaque on transillumination.
• Clear zone: Thin, has no chordae tendineae insertions, clear on transillumination. Attaches to mitral annulus.

Question 23

What structure is the mitral valve anterior leaflet located next to?

Answer 23

The mitral valve anterior leaflet is located next to the posterior part of the aortic root and is also fixed to it via the mitral annulus.

Question 24

How much of the mitral annulus is taken up by the posterior mitral leaflet?

Answer 24

Two thirds.

Question 25

What are the zones of the posterior mitral leaflet?

Answer 25

• Basal zone: Attaches to mitral annulus. Has basal chordae tendineae insertions.
• Clear zone: No chordae tendineae insertions, clear on transillumination.
• Rough zone: Has chordae tendineae insertions. Thicker tissue.

Question 26

Do the commisural leaflets have chordae tendineae insertion?

Answer 26

Each commissural leaflet has a direct chordal tendon into the free margin of the leaflet from the corresponding papillary muscle, with projections into the core of the leaflet towards its base.

Question 27

What is the standard circumference for the mitral valve?

Answer 27

• Male: 9cm
• Female: 7.2cm

Question 28

What is the standard area of the mitral valve?

Answer 28

7 cm²

Question 29

What is the standard diameter of the mitral valve?
And how is this indexed to BMI?

Answer 29

• 3.0cm (longest between commissures, shortest at right angles to this).
• 1.7-1.8cm/m²