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Pathophysiology of the Mitral Valve

Tomasz A. Timek, MD, PhD, James I. Fann, MD
Pathophysiology of the Mitral Valve is a topic covered in the Adult and Pediatric Cardiac.

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Historical Perspective

Detailed description of mitral valve anatomy based on laboratory dissection was introduced by Leonardo da Vinci at the beginning of the 16th century, thus paving the way for subsequent study of its form and function (Figure 1). However, investigations of the surgical treatment of mitral valve disease did not blossom until almost 300 years later, beginning with Sir Brunton’s initial observations relating to the potential for operative relief of mitral stenosis in 1902.[1] The first successful partial resection of a stenotic mitral valve was performed by Cutler and Levine[2] in 1922, whereas mitral commissurotomy was introduced by Soutter in 1925.[3] It was not until the work of Harken and Bailey in the late 1940s with closed mitral commissurotomy that a more reliable operation was available.[4],[5] With introduction of cardiopulmonary bypass in 1953, direct visualization of the mitral valve and valvular repair became feasible. Starr performed the first mitral valve replacement in 1961, quickly becoming the treatment for mitral valve disease not amenable to open commissurotomy.[6] From the early days of mitral valve surgery, some surgeons have attempted to repair and preserve the mitral valve.[7] These investigators continued the pioneering efforts of Lillehei[8] in an effort to repair rather than replace the mitral valve. Kay, Reed, Wooler, and others continued to explore techniques for repairing incompetent valves during this time.[9],[10],[11] In the early 1970s, Carpentier introduced a new classification system for mitral insufficiency and described operations for correcting leaflet abnormalities as well as annuloplasty techniques.[12] Duran, Cosgrove, and others have enhanced these repair techniques with the use of reduction ring annuloplasty.[13],[14] Minimally invasive mitral valve surgery and robotic mitral valve surgery subsequently evolved since the 1990s[15],[16],[17] to accepted standards in today’s clinical practice. Additionally, percutaneous catheter-based mitral valve procedures are being evaluated. See Transcatheter Mitral Valve Repair chapter (G.12)[18],[19] The dynamic evolution of procedural and technological advancement in the field of mitral valve surgery must continue to be rooted in deep and detailed understanding of the intricate physiologic interplay of the mitral valve complex.

Figure 1
Descriptive text is not available for this image
Leonardo da Vinci’s drawings of the mitral valve based on anatomical dissection circa 1504.

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Historical Perspective

Detailed description of mitral valve anatomy based on laboratory dissection was introduced by Leonardo da Vinci at the beginning of the 16th century, thus paving the way for subsequent study of its form and function (Figure 1). However, investigations of the surgical treatment of mitral valve disease did not blossom until almost 300 years later, beginning with Sir Brunton’s initial observations relating to the potential for operative relief of mitral stenosis in 1902.[1] The first successful partial resection of a stenotic mitral valve was performed by Cutler and Levine[2] in 1922, whereas mitral commissurotomy was introduced by Soutter in 1925.[3] It was not until the work of Harken and Bailey in the late 1940s with closed mitral commissurotomy that a more reliable operation was available.[4],[5] With introduction of cardiopulmonary bypass in 1953, direct visualization of the mitral valve and valvular repair became feasible. Starr performed the first mitral valve replacement in 1961, quickly becoming the treatment for mitral valve disease not amenable to open commissurotomy.[6] From the early days of mitral valve surgery, some surgeons have attempted to repair and preserve the mitral valve.[7] These investigators continued the pioneering efforts of Lillehei[8] in an effort to repair rather than replace the mitral valve. Kay, Reed, Wooler, and others continued to explore techniques for repairing incompetent valves during this time.[9],[10],[11] In the early 1970s, Carpentier introduced a new classification system for mitral insufficiency and described operations for correcting leaflet abnormalities as well as annuloplasty techniques.[12] Duran, Cosgrove, and others have enhanced these repair techniques with the use of reduction ring annuloplasty.[13],[14] Minimally invasive mitral valve surgery and robotic mitral valve surgery subsequently evolved since the 1990s[15],[16],[17] to accepted standards in today’s clinical practice. Additionally, percutaneous catheter-based mitral valve procedures are being evaluated. See Transcatheter Mitral Valve Repair chapter (G.12)[18],[19] The dynamic evolution of procedural and technological advancement in the field of mitral valve surgery must continue to be rooted in deep and detailed understanding of the intricate physiologic interplay of the mitral valve complex.

Figure 1
Descriptive text is not available for this image
Leonardo da Vinci’s drawings of the mitral valve based on anatomical dissection circa 1504.

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Last updated: September 29, 2020