REVIEW PAPER
Anatomical and clinical aspects of the papillary muscles
1
Department of Anatomy, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland
2
Cardiology Clinic, Centrum Medyczne Graniczna, Katowice, Poland
Submission date: 2023-12-10
Final revision date: 2024-05-21
Acceptance date: 2024-06-23
Publication date: 2024-09-13
Corresponding author
Radosław Karaś
Department of Anatomy, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland
Department of Anatomy, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland
Medical Studies 2024;40(3):279-288
KEYWORDS
TOPICS
ABSTRACT
Papillary muscles, as components of the subvalvular apparatus, play a crucial role in the proper functioning of the heart valves. Although the most commonly encountered variants can be classified traditionally, it is essential to remember that there is significant variability in their number, structure, and shape. This variability is not without clinical significance – specific papillary muscle variants translate into different prognoses, therapeutic approaches, and surgical procedures. Therefore, in our study, we conducted an analysis of available literature to determine which papillary muscle variants are most common, what their vascular supply is, and what the significance of individual variants is in daily clinical practice. To achieve this, we searched popular scientific databases such as PubMed, Google Scholar, and Scopus, using keywords such as papillary muscles, clinical aspects of papillary muscles, anatomical variability of papillary muscles, and papillary muscle rupture – as one of the most common clinical situations related to papillary muscles. This paper presents the results of our review – organised and accompanied by a table.
REFERENCES (45)
1.
Chen S, Sari CR, Gao H, Lei Y, Segers P, De Beule M, Wang G, Ma X. Mechanical and morphometric study of mitral valve chordae tendineae and related papillary muscle. J Mech Behav Biomed Mater. 2020; 111: 104011.
2.
Xanthos T, Dalivigkas I, Ekmektzoglu K. Anatomic variations of cardiac valves and papillary muscles of the right heart. Ital J Anat Embryol. 2011; 116(2): 111-126.
3.
Zalewski J, Nessler J. Niedomykalność zastawki mitralnej. Część I. Mechanizmy i etiologia. Kardiol Inwazyjna. 2016; 11(1): 21-24.
4.
Ramsheyi SA, Pargaonkar S, Lassau JP, Acar C. Morphologic classification of the mitral papillary muscles. J Heart Valve Dis. 1996; 5(5): 472-476.
5.
Rodriguez F, Langer F, Harrington KB, Tibayan FA, Zasio MK, Liang D, Daughters GT, Ingels NB, Miller DC. Effect of cutting second-order chordae on in-vivo anterior mitral leaflet compound curvature. J Heart Valve Dis. 2005; 14(5): 592-601.
6.
Rodriguez F, Langer F, Harrington KB, Tibayan FA, Zasio MK, Cheng A, Liang D, Daughters GT, Covell JW, Criscione JC, Ingels NB, Miller DC. Importance of mitral valve second-order chordae for left ventricular geometry, wall thickening mechanics, and global systolic function. Circulation. 2004; 110(11 Suppl 1): 115-122.
7.
Oosthoek PW, Wenink AC, Wisse LJ, Gittenberger-de Groot AC. Development of the papillary muscles of the mitral valve: morphogenetic background of parachute-like asymmetric mitral valves and other mitral valve anomalies. J Thorac Cardiovasc Surg. 1998; 116(1): 36-46.
8.
Lamers WH, Virágh S, Wessels A, Moorman AF, Anderson RH. Formation of the tricuspid valve in the human heart. Circulation. 1995; 91(1): 111-121.
9.
Kuta W, Kosiński A, Kozłowski D, Nowicka E, Grzybiak M. Histological remarks regarding the structure of the septal papillary muscles in the hearts of elderly people. Geriatria. 2012; 6(4): 207-211.
10.
Nigri GR, Di Dio LJ, Baptista CA. Papillary muscles and tendinous cords of the right ventricle of the human heart: morphological characteristics. Surg Radiol Anat. 2001; 23(1): 45-49.
11.
Saha A, Roy S. Papillary muscles of left ventricle-Morphological variations and it’s clinical relevance. Indian Heart J. 2018; 70(6): 894-900.
12.
Zajączkowski MA, Gajić A, Kaczyńska A, Zajączkowski S, Kobiela J, Kamiński R, Kosiński A. Individual variability of vascularization of the anterior papillary muscle within the right ventricle of human heart. PLoS One. 2018; 13(10): e0205786.
13.
Kosiński A, Nowiński J, Kozłowski D, Piwko G, Kuta W, Grzybiak M. The crista supraventricularis in the human heart and its role in the morphogenesis of the septomarginal trabecula. Ann Anat. 2007; 189: 447-456.
14.
Berdajs D, Lajos P, Turina MI. A new classification of the mitral papillary muscle. Med Sci Monit. 2005; 11(1): BR 18-21.
15.
Gunnal SA, Wabale RN, Farooqui MS. Morphological variations of papillary muscles in the mitral valve complex in human cadaveric hearts. Singapore Med J. 2013; 54(1): 44-48.
16.
Hosapatna M, Souza A, Das M, Supriya S, Ankolekar V, Souza AS. Morphology of papillary muscles in human adults: a cadaveric study. Ibnosina J Med BS. 2014; 6(4): 168-172.
17.
Hosapatna M, DSouza A, Ankolekar VH. Morphology of the papillary muscles and the chordae tendineae of the ventricles of adult human hearts. Cardiovasc Pathol. 2022; 56: 107383.
18.
Bhadoria P, Bisht K, Singh B, Tiwari V. Cadaveric study on the morphology and morphometry of heart papillary muscles. Cureus. 2022; 14(2): e22722.
19.
Raj P, Pallavi, Singh AK. Adult human cadaveric heart assessment for anatomical variations of papillary muscles in both the ventricles. IJTPR 2022; 12(6): 143-148.
20.
Kavitha S, Shastri D, Shanthi KC. Morphometric analysis of papillary muscles in both ventricles of hearts. IOSR J Dental Med Sci 2018; 17(3): 26-33.
21.
Radhakrishnan NS. Variations in the number and attachment of papillary muscles. Diss. Stanley Medical College, Chennai, 2009.
22.
Rusu MC, Petrescu CI, Niculescu V, Ionescu N, Vlad M. Considerations on the left papillary muscles microangioarchitecture. Rom J Morphol Embryol. 2006; 47(1): 63-66.
23.
Ranganathan N, Burch GE. Gross morphology and arterial supply of the papillary muscles of the left ventricle of man. Am Heart J. 1969; 77(4): 506-516.
24.
Yuan SM. Parachute mitral valve: Morphology and surgical management. Turk Gogus Kalp Damar Cerrahisi Derg. 2020; 28(1): 219-226.
25.
Marino BS, Kruge LE, Cho CJ, Tomlinson RS, Shera D, Weinberg PM, Gaynor JW, Rychik J. Parachute mitral valve: morphologic descriptors, associated lesions, and outcomes after biventricular repair. J Thorac Cardiovasc Surg. 2009; 137(2): 385-393.
26.
De Busk RF, Harrison DC. The clinical spectrum of papillary-muscle disease. N Engl J Med. 1969; 281: 1458-1467.
27.
Hawranek M, Gąsior M, Nożyński J, Poloński L. Przyczyny zgonów chorych z zawałem serca w dobie leczenia reperfuzyjnego. Folia Cardiol. 2004; 11(4): 239-245.
28.
Singam NSV, Ghafghazi S. Papillary muscle rupture after acute inferior myocardial infarction. Tex Heart Inst J. 2021; 48(4): e186717.
29.
Chevalier P, Burri H, Fahrat F, Cucherat M, Jegaden O, Obadia JF, Kirkorian G, Touboul P. Perioperative outcome and long-term survival of surgery for acute post-infarction mitral regurgitation. Eur J Cardiothorac Surg. 2004; 26(2): 330-335.
30.
Machura M, Hudzik B, Gąsior M. Mechaniczne powikłania zawału serca. Folia Cardiol. 2017; 12(6): 565-569.
31.
Estes EH Jr, Dalton FM, Entman ML, Dixon HB 2nd, Hackel DB. The anatomy and blood supply of the papillary muscles of the left ventricle. Am Heart J. 1966; 71(3): 356-362.
32.
Figueras J, Calvo F, Cortadellas J, Soler-Soler J. Comparison of patients with and without papillary muscle rupture during acute myocardial infarction. Am J Cardiol. 1997; 80(5): 625-627.
33.
Naksuk N, Kapa S, Asirvatham SJ. Spectrum of ventricular arrhythmias arising from papillary muscle in the structurally normal heart. Card Electrophysiol Clin. 2016; 8(3): 555-565.
34.
Edward JA, Zipse MM, Tompkins C, Varosy PD, Sandhu A, Rosenberg M, Aleong R, Tzou WS, Borne RT, Sauer WH, Nguyen DT. Follow-up after catheter ablation of papillary muscles and valve cusps. JACC Clin Electrophysiol. 2019; 5(10): 1185-1196.
35.
Piccione W, Goldin M. Mitral valve dysfunction following papillary muscles cryoablation. Ann Thorac Surg. 1988; 46(3): 347-348.
36.
Mochizuki A, Nagahara D, Takahashi H, Saito R, Fujito T, Miura T. Worsening of mitral valve regurgitation after radiofrequency catheter ablation of ventricular arrhythmia originating from a left ventricular papillary muscle. HeartRhythm Case Rep. 2017; 3(4): 215-218.
37.
Pothineni NVK, Santangeli P. Mitral valve regurgitation after papillary muscle ablation: a nonissue? J Cardiovasc Electrophysiol. 2021; 32(7): 1937-1938.
38.
Davachi F, Moller JH, Edwards JE. Diseases of the mitral valve in infancy. An anatomic analysis of 55 cases. Circulation. 1971; 43(4): 565-579.
39.
Sinfield S, Ranasinghe S, Wang S, Mendoza F, Khoynezhad A. Shone’s complex and aortic dissection: case report and review of a rare, underdiagnosed congenital heart disease. J Cardiothorac Surg. 2022; 17(1): 21.
40.
Chandra S, Kharwar RB, Mundhekar A. Shone complex. J Cardiovasc Ultrasound. 2015; 23(1): 54-55.
41.
Rajiah P, Fulton NL, Bolen M. Magnetic resonance imaging of the papillary muscles of the left ventricle: normal anatomy, variants, and abnormalities. Insights Imaging. 2019; 10(1): 83.
42.
Ker J. Right ventricular variants and pulmonary embolism-association or coincidence? Clin Med Insights Cardiol. 2010; 21(4): 53-57.
43.
Lazzari JO, Fachinat A, Tambussi A. Clinical assessment of the right ventricle anterior papillary muscle extrasystoles with Holter recordings. Pacing Clin Electrophysiol. 1990; 13(3): 275-284.
44.
Kumar A, Avishay DM, Jones CR, Shaikh JD, Kaur R, Aljadah M, Kichloo A, Shiwalkar N, Keshavamurthy S. Sudden cardiac death: epidemiology, pathogenesis and management. Rev Cardiovasc Med. 2021; 22(1): 147-158.
45.
Aktas EO, Govsa F, Kocak A, Boydak B, Yavuz IC. Variations in the papillary muscles of normal tricuspid valve and their clinical relevance in medicolegal autopsies. Saudi Med J. 2004; 25(9): 1176-1185.
| eISSN: | 2300-6722 |
| ISSN: | 1899-1874 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
