title: Morphometric study of the human mitral annulus: guide for mitral valve surgery.
abstract: BACKGROUND
  during mitral valve surgery, it is important for surgeons to understand the anatomy of the mitral valve annulus to prevent surgical complications. This study aimed to perform morphometry of the mitral annulus to facilitate secure suturing during ring annuloplasty or replacement of the mitral valve.
  
  
  METHODS
  an anatomical study was carried out on 7 human hearts. We divided the mitral valve annulus into sections containing 8 different points. It was noted that the annulus was a complex structure which has fibrous continuity with the mitral leaflets, and with or without the aortic annulus.
  
  
  RESULTS
  there was always a segment of the annular fibrous structure which was facing directly toward the left ventricular cavity. The length of the segment ranged from 1.0 to 3.4 mm. In terms of the size of the annulus, there were large variations within the subject and among the subjects. The shortest distance between the mitral annulus and left circumflex coronary artery was at the anterolateral commissure, and the length was 3.3 mm.
  
  
  CONCLUSIONS
  this study has improved understanding of the anatomy of the mitral annulus, which could help surgeons to avoid operative complications. Based on this study, several suggestions are made for placing sutures for mitral valve replacement and mitral ring annuloplasty.
authors.affiliation: Department of Cardiovascular Surgery, Kyushu University, Fukuoka, Japan Division of Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan masataka@clnc.uoeh-u.ac.jp.
authors.forename: Masataka
authors.initials: M
authors.lastname: Eto
authors.affiliation: Department of Cardiovascular Surgery, Kyushu University, Fukuoka, Japan Department of Cardiovascular Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Morita
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nakashima
authors.affiliation: Division of Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nishimura
authors.affiliation: Department of Cardiovascular Surgery, Kyushu University, Fukuoka, Japan.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Tominaga
mesh_terms: D059925:Anatomic Landmarks; D001344:Autopsy; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000033:anatomy & histology* / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000295:instrumentation; D011474:Prosthesis Design; D013536:Suture Techniques
keywords: Anatomy; cardiac surgical procedures; coronary vessels; heart valve prosthesis implantation; mitral valve; mitral valve annuloplasty; regional