[HSF] mitral valve nomenclature

[Nasser F. Abou'Seada]

Dear Tea 
I do completely concur with your thoughts. 
To my mind, it will need more than just reviewing the nomenclature as it is
related to the orientation and relation of the parts of mitral valve. this
is the easy part of it. I would suggest a more thorough review of the
nomenclature as used topographically by Surgeons during their maneuvers in
MV Reconstruction, trying to unify the descriptive nomenclature as much as
applicable, relating that to classic anatomical orientation. 

A circulating questionnaire, well organized, might be a good preliminary
step, delineating the problem, the current practice, and proposals. A
collective review of the results, as related to descriptive anatomy, and
imaging techniques, would be a further step. Bob can always guide and look
after the our endeavours.  

NFA

> From: Tea Acuff
> I know that we reviewed at least part of this several months ago, but I
can not locate
> the discussion. I have been looking at the spacial relationships between
the mitral
> leaflets, papillary muscles, and ventricular walls with MR. On CMR one can
not see
> which chordae go where or more precisely can not determine how many
supports
> each papillary gives to parts of each leaflet unfortunately. Our usual
nomenclature is
> confusing because as one moves from leaflet to commisures and papillary
muscles to
> the ventricular wall our definitional orientation keeps changing. For
example anterior
> for the leaflet is not anterior to the LV wall, while anterolateral is apt
for the area of
> one commisure, but medial is not a location on the LV wall. The papillary
muscles are
> ant and post to each other, but not strictly to the LV wall as they tend
to a Dr. Pepper
> orientation (!?!)
> I remember a mention of Miller's "Septal" leaflet, which I can locate (on
MR that is),
> but "aortic" may be more correct. I do not remember his system or that of
Duran. Do
> any of these nomenclatures derive from embryological considerations? Can
someone
> review the proposed nomenclature(s), if any, that maintain consistently
these
> orientations as one moves from outside the LV towards the endocardial
surface?
> The nice thing about MR is that unlike the cadaver one can see dynamic
function, it is
> not distorted by death, and one is not continuously turning it (the
specimen) over and
> over trying to get reoriented.
> Tea