IJAR.2018.394

Type of Article:  Original Research

Volume 6; Issue 4.3 (December 2018)

Page No.: 6002-6008

DOI: https://dx.doi.org/10.16965/ijar.2018.394

A COMPARATIVE STUDY OF NUMBER AND POSITION OF PAPILLARY MUSCLES AND CLINICAL SIGNIFICANCE

Soumya S Muraleedharan *1, Sailaja K 2.

*1  MBBS, MD, Lecturer, Dept of Anatomy, Govt. Medical College, Kozhikode, Kerala, India.

2 MBBS, MD, Additional Professor, Dept of Anatomy, Govt Medical College, Manjeri, Kerala, India.

Address for correspondence :  Dr. Soumya S Muraleedharan ,MBBS, MD, Lecturer, Dept of Anatomy, Govt. Medical College, Kozhikode, Kerala, India. E-Mail: soumyasmuraleedharan@gmail.com

ABSTRACT:

Introduction: Papillary muscles are the conical muscle masses project into the cavity of ventricle and are inserted into the valve cusps by chordae tendinae. They prevent the cusps from being forced back into the atrium during ventricular contraction. Their number and positions are highly variable. An anomalous papillary muscle can act as an ectopic foci. Hence these variations should be assessed before any operative intervention on the valve. Present study aim to analyse these variations in detail.

Materials and Methods: This is a descriptive observational study to analyse the variations in number and position of papillary muscles in ventricles of 100 adult human hearts ranging in age from 17 to 80 years obtained from autopsy specimens. The methodology used was the dissection method according to standard autopsy techniques. The data obtained were quantified as frequencies (in %).

Results: Of the 100 hearts studied, the right ventricle consisted of the usual three groups of papillary muscles in 84% of hearts whereas the remaining 16% of hearts had only two groups (rudimentary SPMs). The left ventricle consisted of two groups of papillary muscles in 73% of hearts ; three groups in 23%; four groups in 4% and none of the hearts contained single papillary muscle. Regarding the positions, the right ventricle had APMs in anterobasal position, the PPMs in posterobasal position and SPMs was located close to ventricular septum and no extra group of papillary muscles were found. In left ventricle, 73% of hearts had APMs and PPMs in anterolateral and posteromedial positions respectively, whereas in 27% (23% and 4%) hearts, the extra group of papillary muscles (third group and fourth group) were interlinked to PPMs and was situated in posterolateral position.

Conclusion: These findings suggest that the variations in number and positions of papillary muscles should be anticipated before any operative intervention on the valvular apparatus.

Key words: Anterior Papillary Muscle; Posterior Papillary Muscle; Septal Papillary Muscle.

REFERENCES

  1. Loukas M, Tubbs R.S, Louis R.G. Jr, Apaydin N, Bartczak A, Huseng V, Alsaiegh N, Fudalej M. An endoscopic and anatomical approach to the septal papillary muscle of the conus. Surg. Radiol. Anat. 2009;31:701-706.
  2. Harsha B. R & Dr. Dakshayani K. R. Morphometric Study on Septal Papillary Muscles of Human Tricuspid Valve. Global Journal of Medical research (USA) 2014;14(1):1.
  3. Carney E K, Braunwald E, Roberts W C, Aygen M, MoR Row A G. Congenital mitral regurgitation: Clinical, hemodynamic and angiocardiographic findings in nine patients. J Med 1962;33:223.
  4. Shone JD, Seller RD, Anderson RC, Adams P, Lillehei CW, Edwards JE. The developmental complex of “parachute mitral valve. Supravalvular ring of left atrium, subaortic stenosis, and coaretation of aorta. Amer J Cardiol. 1963;11:714.
  5. William C Roberts MD , Lawrece S Cohen MD. Left Ventricular Papillary Muscles : Description of the normal and a survey of conditions causing them to be abnormal. Circulation, 1972;XLVI:138-154.
  6. Victor S, Nayak V M. Variations in the papillary muscles of the normal mitral valve and their surgical relevance. J Card Surg.1995 Sep;10(5):597-607.
  7. Alper Ucak M.D, Burak Onan M.D, İbrahim Alp M.D, Ahmet Turan Yılmaz M.D. Accessory mitral papillary muscle causing severe aortic insufficiency. Türk Kardiyol Dern Arş – Arch Turk Soc Cardiol 2010;38(8):564-567.
  8. Kuo-Tzu Sung, Chun-Ho Yun, Charles Jia-Yin Hou and Chung-Lieh Hung. Solitary accessory and papillary muscle hypertrophy manifested as dynamic mid-wall obstruction and symptomatic heart failure: diagnostic feasibility by multi-modality imaging. BMC Cardiovascular Disorders 2014;14:34.
  9. Sandhya Arvind Gunnal , Rajendra Namdeo Wabale, Mujeebuddin Samsamuddin Farooqui. Morphological variations of papillary muscles in the mitral valve complex in human cadaveric hearts. Singapore Med J 2013;54(1):44-48.
  10. Mamatha Hosapatna, Anne D Souza, Aswin Das M, Supriya, Vrinda Hari Ankolekar, Antony Sylvan D Souza. Morphology of Papillary Muscles in Human Adults: A Cadaveric study. Ibnosina J Med BS 2014; 6(4):168-172.
  11. Ludwig J. Autopsy manual Cardiovascular System. Handbook of Autopsy Practice, 3rd  2002:45-48.
  12. Nigri G R, Di Dio L J, Baptista C A. Papillary muscles and tendinous cords of the right ventricle of the human heart: morphological characteristics. Surg.Radiol Anat. 2001;23(1):45-49.
  13. Jezyk D., Jerzemowski J., Grzybiak M. Provision of tricuspid valve leaflets by septal papillary muscles in the right ventricle of human and other mammal hearts. Folia Morphol. (Warsz) 2003;62:309-311.
  14. Ekin O. Aktas MD, Figen Govsa MD, Aytac Kocak MD, Bahar Boydak MD, Ismail C. Yavuz MD. Variations  in the papillary muscles of normal tricuspid valve and their clinical relevance in medicolegal autopsies. Saudi Med J 2004;25(9):1176-1185.
  15. Kotaro Oe MD, Tsutomu Araki MD, FJCC, Miho Ohira MD, Tetsuo Konno MD, FJCC, Masakazu Yamagishi MD, FJCC. Left  ventricular outflow tract obstruction with abnormal papillary muscles. Journal of Cardiology Cases . 2015 Feb;11(2):69–72.
  16. Hashimoto K, Oshiumi M, Takakura H, Sasaki T, Onoguchi K. Congenital mitral regurgitation fromabsence of the anterolateral papillary muscle. Thorac Surg 2001;72:1386-1387.
  17. Christopher W. Baird MD, A. Resai Bengur MD, Andrew Bensky MD, and Larry T. Watts, MD, Charlotte, NC. Congenital absence of posteromedial papillary muscle and anterior mitral leaflet chordae: The use of three-dimensional echocardiography and approach in complex pediatric mitral valve disease. The Journal of Thoracic and Cardiovascular Surgery 2010;139(4).
  18. Fumiaki Shikata, Mitsugi Nagashima, Kazuhisa Nishimura, Fuminaga Suetsugu, Kanji Kawachi . Repair of congenitally absent chordae in a Tricuspid valve leaflet with hypoplastic papillary muscle using artificial chordae.  J Card Surg 2010 Nov 29;25(6):737-739.
  19. Castaneda A R, Anderson R C, Edwards J E: Congenital mitral stenosis resulting from anomalous arcade and obstructing papillary muscles: Report of correction by use of ball valve prosthesis. Amer J Cardiol. 1969;24:237.
  20. Barry J. Maron, MD; Rick A. Nishimura, MD;  Gordon K. Danielson, MD. Pitfalls in Clinical Recognition and a Novel Operative Approach for Hypertrophic Cardiomyopathy With Severe Outflow Obstruction Due to Anomalous Papillary Muscle. Circulation 1998; 98:2505-2508.
  21. Teo E P, Teoh J G, Hung J. Mitral valve andpapillary muscle abnormalities in hypertrophic obstructive cardiomyopathy. Curr Opin Cardiol. 2015 Sep ;30(5):475-482.

Cite this article: Soumya S Muraleedharan, Sailaja K. A COMPARATIVE STUDY OF NUMBER AND POSITION OF PAPILLARY MUSCLES AND CLINICAL SIGNIFICANCE. Int J Anat Res 2018;6(4.3):6002-6008. DOI: 10.16965/ijar.2018.394