Download Normal anatomy of the left ventricular papillary muscles

Normal anatomy of the left ventricular papillary muscles
using computed tomography
Poster No.:
438
Congress:
ESCR 2012
Type:
Scientific Exhibit
Authors:
D. Armstrong , J. B. Partridge , M. Williams , E. J. R. Van Beek ,
1
1 1
2
1
1
2
S. Mirsadraee ; Edinburgh/UK, Garran/AU
Keywords:
Anatomy, Cardiac, CT-Angiography, Contrast agent-intravenous,
Education and training
DOI:
10.3205/ESCR.2012.P-438
Any information contained in this pdf file is automatically generated from digital material
submitted to EPOS by third parties in the form of scientific presentations. References
to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in
any way constitute or imply ECR's endorsement, sponsorship or recommendation of the
third party, information, product or service. ECR is not responsible for the content of
these pages and does not make any representations regarding the content or accuracy
of material in this file.
As per copyright regulations, any unauthorised use of the material or parts thereof as
well as commercial reproduction or multiple distribution by any traditional or electronically
based reproduction/publication method ist strictly prohibited.
You agree to defend, indemnify, and hold ECR harmless from and against any and all
claims, damages, costs, and expenses, including attorneys' fees, arising from or related
to your use of these pages.
Please note: Links to movies, ppt slideshows and any other multimedia files are not
available in the pdf version of presentations.
www.escr.org
Page 1 of 5
Purpose
Computed tomography (CT) of the heart offers high spatial resolution images, providing
an excellent platform to analyze cardiac anatomy. The objective here was to use CT to
provide a descriptive analysis of normal left ventricular papillary muscle (PM) morphology.
Methods and Materials
Normal CT coronary angiograms, acquired using a 320 slice scanner (Toshiba Aquilion
ONE) were retrospectively reviewed in 79 patients (m/f = 27/52; age 49+/-32 years).
PMs were distinguished from other trabecular structures by the presence of chordae
tendineae. The number of PMs in each ventricle, their attachment to the ventricular wall,
and their morphology were examined using multi-planar reconstructions.
Results
The number of PMs identified in each ventricle ranged from 2-4 (2PMs=75%, 3PMs=23%,
4PMs=2%) (Fig 1). PMs were typically conical in shape, tapering from a broad base on
the lateral or inferior free wall. Many muscles consisted of two or more bodies converging
or separating to form single or multiple "heads". The majority of muscles displayed
more than one "head" or apex (Fig 2) with attaching chordae (single head=28%, double
head=59%, multiple heads=13%). It was also observed that the chordae did not only
attach to the tip of the apex, but also at multiple points along the apical end of the muscle.
The morphology varied greatly between individuals and between muscles within the same
ventricle. 91% of all PMs arose from multiple points of attachment on the ventricular
wall. The current nomenclature used to describe the position of the PMs was found to
be inaccurate, with the main muscles being in a superior-inferior relationship rather than
anterolateral/posteromedial (Fig 3).
Images for this section:
Page 2 of 5
Fig. 1: 3 distinct conical shaped papillary muscles within the left ventricle, each with
multiple points of attachment to the ventricle wall.
Fig. 2: Each muscle has multiple heads with chordae attaching to the valve leaflets and
each muscle arises from multiple points along the ventricular wall.
Page 3 of 5
Fig. 3: The 2 papillary muscles are clearly in a superior/inferior relationship; however,
their medial/lateral and anterior/posterior relationships are less well defined.
Page 4 of 5
Conclusion
There is great variability in both the number and the morphology of the left ventricular
papillary muscles, to the extent that their pattern could be considered unique to each
person. This variation needs to be considered when investigating for mitral valvular
pathologies.
References
.
Personal Information
Page 5 of 5