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Thorac Cardiovasc Surg 2003; 51(4): 190-195
DOI: 10.1055/s-2003-42261
Original Cardiovascular
© Georg Thieme Verlag Stuttgart · New York

The Aortomitral Angle is Suspended by the Anterior Mitral Basal “Stay” Chords

W.  A.  Goetz1 , H.-S.  Lim2 , E.  Lansac3 , P.  A.  Weber2 , D.  E.  Birnbaum1 , C.  M. G.  Duran2
  • 1Klinik für Herz-, Thorax- und herznahe Gefäßchirurgie, Klinikum der Universität Regensburg, Germany
  • 2The International Heart Institute of Montana Foundation at St. Patrick Hospital and Health Sciences Center and The University of Montana, Missoula, Montana, USA
  • 3Chirurgie Thoracique et Cardiovasculaire, Hopital Pitie-Salpetriere, Paris, France
This paper was presented at the 32nd Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, 23 - 26 February 2003 in Leipzig, Germany; Abstract ID: 16057
Further Information

Publication History

Received March 27, 2003

Publication Date:
19 September 2003 (online)

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Abstract

Objectives: The function of the anterior mitral basal “stay” chords (SC) is not yet known. Collagen fiber orientation of the anterior mitral leaflet (AML) suggests that local stress is directed from papillary muscles (PM) over SC and AML to fibrous trigones (FT), maintaining the aortomitral angle (AMA). It has been shown that narrowing of AMA increases risk of systolic anterior movement (SAM). Methods: Sonomicrometry crystals were implanted in six sheep at the left ventricular (LV) apex, PM tips (M1, M2), FT (T1, T2), posterior mitral annulus (PMA), and base of aortic right coronary sinus (RCS). The retracting force of ascending aorta was measured. Results: Transection of SC resulted in an increase of distance M1-T1 and M2-T2. Consequently, the AMA narrowed at end systole by - 3.26 ± 0.85 ° (p < 0.05) and at end diastole by - 4.16 ± 1.28 ° (p < 0.05). A force of 1.8 ± 0.2 N was needed to pull the recoiling ascending aorta back to its original position. Conclusions: The elastic recoil of ascending aorta is balanced by SC, which connect PM to FT and constitute the center of the LV base. Transection of SC narrows AMA and increases the risk of SAM.

Key words

Aortomitral angle - mitral valve - anterior basal chordae tendinae - stay chords - sonomicrometry

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Carlos M. G.  Duran, MD, PhD 

The International Heart Institute of Montana

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