Mitral valve

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Mitral valve
Anterior (frontal) view of the opened heart. White arrows indicate normal blood flow. (Mitral valve labeled at center right.)
Base of ventricles exposed by removal of the atria. (Bicuspid valve visible at bottom left.)
Latin	valva atrioventricularis sinistra, valva mitralis
Gray's	subject #138 534
MeSH	Mitral+Valve
Dorlands/Elsevier	v_02/12843904

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The mitral valve (also known as the bicuspid valve or left atrioventricular valve), is a dual flap (bi = 2) valve in the heart that lies between the left atrium (LA) and the left ventricle (LV). In Latin, the term mitral means shaped like a miter, or bishop's cap. The mitral valve and the tricuspid valve are known collectively as the atrioventricular valves because they lie between the atria and the ventricles of the heart and control flow.

Overview

A normally functioning mitral valve opens to pressure from the superior surface of the valve, allowing blood to flow into the left ventricle during left atria systole (contraction), and closes at the end of atrial contraction to prevent blood from back flowing into the atria during left ventricle systole. In a normal cardiac cycle, the atria contracts first, filling the ventricle. At the end of ventricular diastole, the bicuspid valve shuts, and prevents backflow as the ventricle begins its systolic phase. Backflow may occur if the patient suffers from mitral valve prolapse, causing an audible heart murmur during auscultation.

Anatomy

The mitral valve has two cusps/leaflets (the anteromedial leaflet and the posterolateral leaflet) which guards the opening. The opening is surrounded by a fibrous ring known as the mitral valve annulus. (The orientation of the two leaflets were once thought to resemble a bishop's miter, which is where the valve receives its name.^[1]) The anterior cusp protects approximately two-thirds of the valve (imagine a crescent moon within the circle, where the crescent represents the posterior cusp). These valve leaflets are prevented from prolapsing into the left atrium by the action of tendons attached to the posterior surface of the valve, chordae tendinae.

The inelastic chordae tendineae are attached at one end to the papillary muscles and the other to the valve cusps. Papillary muscles are finger like projections from the wall of the left ventricle. Chordae tendinae from each muscle are attached to both leaflets of the mitral valve. Thus when the ventricle contracts, the intraventricular pressure forces the valve to close, while the tendons prevent the valve from opening in the wrong direction.

Normal physiology

During left ventricular diastole, after the pressure drops in the left ventricle due to relaxation of the ventricular myocardium, the mitral valve opens, and blood travels from the left atrium to the left ventricle. About 70-80% of the blood that travels across the mitral valve occurs during the early filling phase of the left ventricle. This early filling phase is due to active relaxation of the ventricular myocardium, causing a pressure gradient that allows a rapid flow of blood from the left atrium, across the mitral valve. This early filling across the mitral valve is seen on doppler echocardiography of the mitral valve as the E wave.

After the E wave, there is a period of slow filling of the ventricle.

Left atrial contraction (left atrial systole) (during left ventricular diastole) causes added blood to flow across the mitral valve immediately before left ventricular systole. This late flow across the open mitral valve is seen on doppler echocardiography of the mitral valve as the A wave. The late filling of the LV contributes about 20% to the volume in the left ventricle prior to ventricular systole, and is known as the atrial kick.

Surface anatomy

The opening and closing of the mitral valve is difficult to hear directly, but the flow of blood to the left ventricle is most audible at the apex of the heart, and so auscultation is usually performed at the intersection of the fifth intercostal space and the midclavicular line.

Additional images

Section of the heart showing the ventricular septum. (Bicuspid valve visible at center.)

Front of thorax, showing surface relations of bones, lungs (purple), pleura (blue), and heart (red outline). Heart valves are labeled with "B", "T", "A", and "P".

See also

• Anatomy
  • Heart
  • Heart valve
  • Papillary muscle
• Pathophysiology
  • Mitral valve prolapse
  • Mitral regurgitation
  • Mitral stenosis
• Procedures to fix the mitral valve
  • Mitral valve replacement
  • Mitral valve repair
  • Mitral valvuloplasty

References

1. ↑ Stedman's/LWW 1539731

External links

• SUNY Figs 20:07-03 - "Valves of the heart."
• Mitral Valve Repair at The Mount Sinai Hospital - "Mitral Valve Function"
• Surgical Anatomy of the Mitral Valve at echoincontext.com

v • d • e Anatomy of torso, cardiovascular system: heart
Structures	atria (interatrial septum, musculi pectinati) • ventricles (interventricular septum, trabeculae carneae, chordae tendinae, papillary muscle) • valves • cusps
Regions	base • apex • grooves (coronary/atrioventricular, interatrial, anterior interventricula, posterior interventricular) • surfaces (sternocostal, diaphragmatic) • borders (right, left)
Right heart	(vena cavae, coronary sinus) → right atrium (auricle, fossa ovalis, limbus of fossa ovalis, crista terminalis, valve of the inferior vena cava, valve of the coronary sinus) → tricuspid valve → right ventricle (conus arteriosus, moderator band/septomarginal trabecula)  → pulmonary valve → (pulmonary artery and pulmonary circulation)
Left heart	(pulmonary veins) → left atrium (auricle) → mitral valve → left ventricle → aortic valve (aortic sinus) → (aorta and systemic circulation)
Layers	pericardium: fibrous pericardium • serous pericardium (pericardial cavity, epicardium/visceral layer) • pericardial sinus myocardium • endocardium • cardiac skeleton (fibrous trigone, fibrous rings)
Conduction system	Cardiac pacemaker • SA node • AV node• bundle of His • Purkinje fibers

v • d • e Electrocardiography
Overview	History of the EKG • EKG interpretation basics • Normal sinus rhythm
EKG Complexes	P wave • QRS complex • ST Segment • T wave • U wave Osborn wave • H wave • K wave • Delta wave NSSTW changes
EKG Intervals	PR Interval • QRS Interval • ST Interval • QT Interval
Conduction System & Bradycardia	Cardiac pacemaker • SA node • AV node• Bundle of His • Purkinje fibers • Sinus bradycardia • First Degree AV Block • Second Degree AV Block • Complete or Third-Degree AV Block • Concealed conduction • AV Junctional Rhythms • LBBB • LAHB • LPHB • RBBB • Trifascicular block
Atrial Arrhythmias	Sinus tachycardia • Premature Atrial Contractions (PACs) • Ectopic Atrial Rhythm • Paroxysmal Atrial Tachycardia (PAT) • Paroxysmal Atrial Tachycardia (PAT) with Block • Multifocal Atrial Tachycardia (MAT) • Atrial Flutter • Atrial Fibrillation • Wandering atrial pacemaker
Ventricular Arrhythmias	Differential Diagnosis of Tachycardia with a Wide QRS Complex • Accelerated Idioventricular Rhythm • Ventricular Parasystole • Premature Ventricular Contractions (PVCs) • Ventricular tachycardia • Ventricular Fibrillation • Sudden cardiac death
EKG Abnormalities in Disease States	Hypertrophy & Dilatation • Right atrial enlargement • Left atrial enlargement • Biatrial enlargement • Left Ventricular Hypertrophy • Right Ventricular Hypertrophy • Biventricular Hypertrophy • Acute myocardial infarction • NSTEMI • STEMI • Right ventricular myocardial infarction • Atrial infarction Pre-excitation Syndromes • Wolff-Parkinson-White Syndrome • Lown Ganong Levine Syndrome • Mahaim Type Preexcitation Cardiomyopathies • Arrhythmogenic Right Ventricular Dysplasia • Dilated Cardiomyopathy • Hypertrophic Cardiomyopathy Drug Effects on the EKG • Adenosine • β-blockers • Digitalis • Quinidine • Procainamide • Disopyramide • Lidocaine • Tocainide and Mexiletine • Phenytoin • Encainide, Flecainide and Propafenone • Amiodarone • Bretylium • Ca Channel Blockers • Phenothiazines • Tricyclic Antidepressants • Lithium Congenital Heart Disease • Dextrocardia • Atrial Septal Defect • Ventricular Septal Defect • Tetralogy of Fallot • Conjoined Twins or Siamese Twins Electrolyte Disturbances • Hyperkalemia • Hypokalemia • Hypercalcemia • Hypocalcemia • Nonspecific Changes Other Heart Diseases • Pericarditis • Myocarditis • Tamponade • Heart Transplantation • Sick Sinus Syndrome • Long QT Syndrome Inherited Disease • Brugada Syndrome Systemic Diseases • CNS Disease • Cardiac Tumors Heart Transplantation • EKG Changes in patient with Heart Transplantation Exogenous Effects • Hypothermia • Chest Trauma • Insect Bites • Electric Injuries
Technical Issues and Potential Errors in Interpretation	Artifacts • Lead Placement Errors • The EKG in a Patient with a Pacemaker

v • d • e Circulatory system pathology (I, 390-459)
Hypertension	Hypertensive heart disease - Hypertensive nephropathy - Secondary hypertension (Renovascular hypertension)
Ischaemic heart disease	Angina pectoris (Prinzmetal's angina) - Myocardial infarction (heart attack) - Dressler's syndrome
Pulmonary circulation	Pulmonary embolism - Cor pulmonale
Pericardium	Pericarditis - Pericardial effusion - Cardiac tamponade
Endocardium/heart valves	Endocarditis - mitral valve (regurgitation, prolapse, stenosis) - aortic valve (stenosis, insufficiency) - pulmonary valve (stenosis, insufficiency) - tricuspid valve (stenosis, insufficiency)
Myocardium	Myocarditis - Cardiomyopathy (Dilated cardiomyopathy, Hypertrophic cardiomyopathy, Loeffler endocarditis, Restrictive cardiomyopathy) - Arrhythmogenic right ventricular dysplasia
Electrical conduction system of the heart	Heart block: AV block (First degree, Second degree, Third degree) - Bundle branch block (Left, Right) - Bifascicular block - Trifascicular block Pre-excitation syndrome (Wolff-Parkinson-White, Lown-Ganong-Levine) - Long QT syndrome - Adams-Stokes syndrome - Cardiac arrest - Sudden cardiac death Arrhythmia: Paroxysmal tachycardia (Supraventricular, AV nodal reentrant, Ventricular) - Atrial flutter - Atrial fibrillation (Familial) - Ventricular fibrillation - Premature contraction (Atrial, Ventricular) - Ectopic pacemaker - Sick sinus syndrome
Other heart conditions	Heart failure - Cardiovascular disease - Cardiomegaly - Ventricular hypertrophy (Left, Right)
Cerebrovascular diseases	Stroke - Transient ischemic attack - Intracranial hemorrhage/cerebral hemorrhage: Extra-axial hemorrhage (Epidural hemorrhage, Subdural hemorrhage, Subarachnoid hemorrhage) Intra-axial hematoma (Intraventricular hemorrhages, Intraparenchymal hemorrhage) - Anterior spinal artery syndrome - Binswanger's disease - Moyamoya disease
Arteries, arterioles and capillaries	Atherosclerosis (Renal artery stenosis) - Aortic dissection/Aortic aneurysm (Abdominal aortic aneurysm) - Aneurysm - Raynaud's phenomenon/Raynaud's disease - Buerger's disease - Vasculitis/Arteritis (Aortitis) - Intermittent claudication - Arteriovenous fistula - Hereditary hemorrhagic telangiectasia - Spider angioma - Dissection (Carotid artery, Vertebral artery)
Veins, lymphatic vessels and lymph nodes	Thrombosis/Phlebitis/Thrombophlebitis (Deep vein thrombosis, May-Thurner syndrome, Portal vein thrombosis, Venous thrombosis, Budd-Chiari syndrome, Renal vein thrombosis, Paget-Schroetter disease) - Varicose veins / Portacaval anastomosis (Hemorrhoid, Esophageal varices, Varicocele, Gastric varices, Caput medusae) - Superior vena cava syndrome - Lymph (Lymphadenitis, Lymphedema, Lymphangitis)
Other	Hypotension (Orthostatic hypotension) - Rheumatic fever
See also congenital (Q20-Q28, 745-747)

v • d • e WikiDoc Research Resources for Mitral valve (Click show to right to view)
Articles on Mitral valve	Most recent articles on Mitral valve • Most cited articles on Mitral valve • Review articles on Mitral valve • Articles on Mitral valve in N Eng J Med, Lancet, BMJ
Media (Slides, Video, Images, MP3) on Mitral valve	Powerpoint slides on Mitral valve • Images of Mitral valve • Photos of Mitral valve • Podcasts & MP3s on Mitral valve • Videos on Mitral valve
Evidence Based Medicine Regarding Mitral valve	Cochrane Collaboration on Mitral valve • Bandolier on Mitral valve • TRIP on Mitral valve
Cost Effectiveness of Mitral valve	Cost Effectiveness of Mitral valve
Clinical Trials Involving Mitral valve	Ongoing Trials on Mitral valve at Clinical Trials.gov • Trial results on Mitral valve • Clinical Trials on Mitral valve at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding Mitral valve	US National Guidelines Clearinghouse on Mitral valve • NICE Guidance on Mitral valve • NHS PRODIGY Guidance • FDA on Mitral valve • CDC on Mitral valve
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Continuing Medical Education (CME) Programs on Mitral valve	CME Programs on Mitral valve
International Resources on Mitral valve	Mitral valve en Espanol • Mitral valve en Francais
Business Resources on Mitral valve	Mitral valve in the Marketplace • Patents on Mitral valve
Informatics Resources on Mitral valve	List of terms related to Mitral valve

de:Mitralklappe it:Mitrale ja:僧帽弁 nn:Mitralklaff

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Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .