title: Distance between mitral anulus and papillary muscles: anatomic study in normal human hearts.
abstract: BACKGROUND
  Preservation of the annulo-papillary muscle continuity in mitral valve replacement is important. Even in patients who require excision of the mitral apparatus, the continuity can be restored. However, there is no guide to the proper length for the resuspension.
  
  
  METHODS
  In 57 normal cadaveric hearts, the distance from the tip of the papillary muscle to its corresponding mitral anulus was directly measured.
  
  
  RESULTS
  The distance from the tip of the anterolateral papillary muscle to the left trigone (10-o'clock position: D10) and to the point between the anterior and the middle scallops of the mural leaflet (8-o'clock position: D8) was 23.5 +/- 3.7 mm and 23.2 +/- 3.6 mm, respectively. The distance from the tip of the posteromedial papillary muscle to the right trigone (2-o'clock position: D2) and to the point between the middle and the posterior scallops of the mural leaflet (4-o'clock position: D4) was 23.5 +/- 4.0 mm and 23.5 +/- 3.9 mm, respectively. There was no statistically significant difference among the 4 distances (P =.96). Each distance was significantly longer than the corresponding chordae tendineae (D10 vs the anterior main chorda: 17.2 +/- 3.9 mm, D8 vs the anterior cleft chorda: 14.5 +/- 3.2 mm, D2 vs the posterior main chorda: 17.9 +/- 4.3 mm, and D4 vs the posterior cleft chorda: 14.9 +/- 3.2 mm, respectively; P =.0001). The mean distance had a significant correlation with the mitral annular diameter (r = 0.31, P =.019).
  
  
  CONCLUSIONS
  In normal hearts, the annulo-papillary muscle distances of the mitral apparatus are similar in 2-, 4-, 8-, and 10-o'clock positions and correlate with the mitral annular diameter.
authors.affiliation: Department of Cardiovascular Surgery, Tenri Hospital, Nara, Osaka, Japan. tedsakai@hotmail.com
authors.forename: T
authors.initials: T
authors.lastname: Sakai
authors.forename: Y
authors.initials: Y
authors.lastname: Okita
authors.forename: Y
authors.initials: Y
authors.lastname: Ueda
authors.forename: T
authors.initials: T
authors.lastname: Tahata
authors.forename: H
authors.initials: H
authors.lastname: Ogino
authors.forename: K
authors.initials: K
authors.lastname: Matsuyama
authors.forename: S
authors.initials: S
authors.lastname: Miki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001830:Body Surface Area; D002102:Cadaver; D002815:Chordae Tendineae / Q000033:anatomy & histology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000033:anatomy & histology* / Q000601:surgery; D009929:Organ Size; D010210:Papillary Muscles / Q000033:anatomy & histology*; D012044:Regression Analysis