Berdajs Denis, Zünd Gregor, Camenisch Colette, Schurr Ulrich, Turina Marko I, Genoni Michele
University Hospital Zürich, Department of Cardiovascular Surgery, Rämistrasse, Zürich, Switzerland.
J Card Surg. 2007 Sep-Oct;22(5):406-9. doi: 10.1111/j.1540-8191.2007.00449.x.
Surgical repair of the mitral valve is in most cases limited to the posterior leaflet of the mitral valve and to the annulus fibrosus. The term annulus fibrosus is still used in anatomical and clinical terminology and is described as a cord like structure providing the attachment of the mitral vale. However, to date no evidence exists of a ring-or cord-like structure at this area. Herein, we describe the attachment of the mitral valve by using the macroscopical and microscopical techniques.
The ventricular attachment of the posterior mitral valve leaflet was investigated in 10 human hearts. In dry dissected specimens, the intraventricular illumination was used to identify the attachment of the mitral valve to the left ventricular muscle. Using the histological techniques, we verified the position of the annulus fibrosus.
The attachment of the posterior mitral valve leaflet is a band-like structure positioned between the left ventricular muscle and the left atrium. This fibrous band illustrates the morphological attachment of the mitral valve and, as thus, was interpreted as the annulus fibrosus of the mitral valve.
Based on our data, no ring-like structure was found corresponding to the anatomical description of the annulus fibrosus, instead the band-like fibrous tissue was identified positioned between the mitral valve and the left ventricle. Histologicaly, we detected that this structure is part of the greater structural system that is directly connected to the membranous septum, to the left and right fibrous trigone and the attachment aortic root to the left ventricular muscle.
在大多数情况下，二尖瓣手术修复仅限于二尖瓣后叶和纤维环。纤维环这一术语仍用于解剖学和临床术语中，被描述为一种类似绳索的结构，用于固定二尖瓣。然而，迄今为止，在该区域尚无环形或绳索状结构的证据。在此，我们使用宏观和微观技术描述二尖瓣的附着情况。
对10颗人类心脏的二尖瓣后叶心室附着情况进行了研究。在干燥解剖标本中，利用心室内照明来确定二尖瓣与左心室肌肉的附着情况。使用组织学技术，我们验证了纤维环的位置。
二尖瓣后叶的附着是位于左心室肌肉和左心房之间的带状结构。这条纤维带说明了二尖瓣的形态附着，因此被解释为二尖瓣的纤维环。
根据我们的数据，未发现与纤维环解剖描述相对应的环状结构，而是在二尖瓣和左心室之间发现了带状纤维组织。在组织学上，我们检测到该结构是更大结构系统的一部分，该系统直接与膜性间隔、左右纤维三角以及主动脉根部与左心室肌肉的附着相连。
