Morphometric study on posterior papillary muscles of human tricuspid valve

Morphometric study on posterior papillary muscles of tricuspid valve ISSN: 2394-0026 (P)Original Research Article ISSN: 2394-0034 (O)Morphometric study on posterior papillary muscles of human tricuspid valveHarsha B.R.1*, Chandrashekar K.T.2, Dakshayani K.R.3 1Assistant Professor, Department of Anatomy, CIMS, Karnataka, India2Assistant Professor, Department of Anatomy, MMC&RI, Mysore, Karnataka, India3Professor and Head, Department of Anatomy, MMC&RI, Mysore, Karnataka, India*Corresponding author email: [email protected] to cite this article: Harsha B.R., Chandrashekar K.T., Dakshayani K.R. Morphometric study onposterior papillary muscles of human tricuspid valve. IAIM, 2015; 2(2): 34-38.Available online at www.iaimjournal.comReceived on: 03-01-2015 Accepted on: 15-01-2015AbstractBackground: Aim of the present study was to observe the measurements of posterior papillarymuscles present in tricuspid valve of human heart. Measurements of posterior papillary muscles intricuspid valve gains utmost importance in cardiac surgeries because they are the causes ofmyocardial infarction in recent times because of its variations and detection of these causes byadvent in modern technologies which will help in treatment of tricuspid valve diseases.Material and methods: This study was carried out on 96 normal formalin fixed human heartspecimens. Dissection was performed according to standard techniques. Posterior papillary muscleswere observed and length, width and thickness of each muscle were measured and documented.Results: In the present study, numbers of posterior papillary muscles were present with a frequencyof 0-7, with most common appearance of 2 muscles in 38 hearts (39.6%) and least commonincidence of 0 muscles in 1 heart (1%). Posterior papillary muscles were present in 95 hearts, withmaximum number of 7 muscles in 1 heart (1%) and minimum number of 1 muscle in 27 hearts(28.1%). In measurements of papillary muscles, posterior papillary muscle mean height was1.05±0.37 cm, mean width was 0.63±0.17 cm and mean thickness was 0.5±0.11 cm respectively.Conclusion: This study serves to understand the morphometry of posterior papillary muscles betterand can help in various surgical procedures and cardiac treatment done on tricuspid valve.Key wordsTricuspid valve, Papillary muscle, Morphometry.Introduction the anatomy of the involved part of the body. As a result of such studies, current notions may beThe opening of a new field of surgical endeavour changed and extended so as to understandoften arouses interest in the detailed study of better. The impetus given to tricuspid valveInternational Archives of Integrated Medicine, Vol. 2, Issue 2, February, 2015. Page 34Copy right © 2015, IAIM, All Rights Reserved.

Morphometric study on posterior papillary muscles of tricuspid valve ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)surgery in the course of the last few years has commissure. It is frequently bifid or trifid. It isprompted revision of our knowledge concerning irregular in size and position.the anatomy of the normal. In present study themorphometry of posterior papillary muscles in All the papillary muscles supply the chordae totricuspid valve were studied and then compared adjacent components of the leaflets theywith the works of many eminent scientists in support. The septomarginal trabeculaethis field. (moderator band) is more or less isolated trabeculae of the bridge type, which extendsThe atrio-ventricular valvular complex in both from inter ventricular septum to the base of theright and left ventricles consists of the orifice anterior papillary muscle in the lower part of theand its annulus, the cusps, the supporting ventricle. It contains conducting myofibers fromchordae tendinae of various types and the the right limb of the atrio-ventricular bundle [1].papillary muscles. Tricuspid valve is made up ofsix major components. Material and methods• Right atrial wall• Annulus The study was carried out on 96 formalin fixed• Three leaflets human hearts from patients who had died of• Chordae tendinae non-vascular causes and were autopsied. No• Papillary muscles gross abnormality of the tricuspid valves was• Right ventricular free wall. noted. Study was done without any grouping of specimens on the basis of sex and age.Harmonious interplay of all these, together with Dissection was performed according to standardthe atrial and ventricular myocardial masses autopsy techniques. The Tricuspid valve wasdepends on the conducting tissues and the opened by a scalpel knife cut passing from themechanical cohesion provided by the fibro right atrium to the apex of the right ventricleelastic cardiac skeleton. through the lateral or acute margin of the ventricle. The interior of the heart was washedAll parts change substantially in position, shape, and all the blood clots were removed. Theangulation and dimensions during a single second cut was made along the anterior surfacecardiac cycle. The papillary muscles were small of the heart just left to the intra-ventricularmuscle groups which were present in ventricular groove from apex of the ventricle to annulus;wall and attached to cusps of valve by chordae care was taken not to damage the papillarytendinae. They contract to prevent invert or muscles. Each muscle were measured by usingprolapse of valve. There are 2 major and 1 minor Vernier callipers and documented.papillary muscle in the right ventricle. The majorpapillary muscles are located in the anterior and The data were summarised using descriptiveposterior positions. The minor papillary muscles statistics like frequency (number of papillaryhave a medial position along with several muscles), mean, standard deviation, range andsmaller and variable muscles attached to the 95% confidence interval (measurement ofventricular septum. papillary muscles). All the statistical calculations were performed using software SPSS forThe posterior or inferior muscle arises from the windows {Statistical Package for Social Servicemyocardium below the inferoseptal (SPSS) Inc, 2004, New York} version 13.0.International Archives of Integrated Medicine, Vol. 2, Issue 2, February, 2015. Page 35Copy right © 2015, IAIM, All Rights Reserved.

Morphometric study on posterior papillary muscles of tricuspid valve ISSN: 2394-0026 (P)Results ISSN: 2394-0034 (O) thickness was 0.5 cm ranged between 0.2 cm and 0.8 cm. Comparison of this observation withIn the present study, number of posterior other studies was as per Table - 2.papillary muscles (PPM) was present with a Table - 1: Comparison of incidence of posteriorfrequency of 0-7. Maximum numbers ofpapillary muscles were 7 seen in only one heart papillary muscles.(1%) and minimum numbers of papillary muscleswere 1 seen in 27 hearts (28.1%). Posterior Sr Studies No of % ofpapillary muscles were present in 95 (98.95%)hearts, with commonest incidence of 2 muscles No cases PPMin 38 hearts (39.6%) and least commonincidence of 0 muscles in only one heart (1%). studied 1 Present study 96 100 2 Balachandra N, et al. [3] 96 100 3 Gerola LR, et al. [4] 50 84 4 Nigri GR, et al. [5] 50 100 5 Motabagani MAB [6] 10 100In measurements of papillary muscles, posterior 6 Begum, et al. [7] 50 60papillary muscle mean height was 1.05±0.37 cm, 7 Wafae N, et al. [8] 50 100mean width was 0.63±0.17 cm and meanthickness was 0.5±0.11 cm respectively. Observations of mean height were significantly higher in posterior papillary muscles, same wayDiscussion observations of mean width shows significantly minimal difference. But none of the above mentioned authors commented about thicknessThe number, length and shape of papillary of the papillary muscles.muscles and chordae tendinae in the rightventricle are variable. This can be of clinical Anatomical variations of papillary muscles wouldsignificance, since the papillary muscles play an be useful in newer surgical techniques likeimportant role in right ventricle contraction by papillotomy and commissurotomy in rheumaticdrawing the tricuspid annulus towards the apex, lesions, leaflet resection in advancedthereby causing shortening of the long axis and myxomatous lesions, excision of infectivethe chamber becoming spherical for ejecting vegetation, transfer and rotation of leafletblood [2]. segments in traumatic conditions and inObservation regarding the percentage of correction of papillary rupture induced Tricuspidpapillary muscles in the present study was in regurgitation. Tricuspid valve in congenitalagreement with the work of all the eminent anomalies like Ebstein’s malformations,workers except Gerola LR, et al. [4] and Begum, dysplasia, straddling is complicated because theet al. [7] as per Table - 1. Possible reason for tendinous chords and papillary muscles aresuch difference is the number of specimens often abnormally short and thick. So knowledgestudied. of a detailed morphology of papillary muscle is more and more necessary for cardiothoracic surgeries of these conditions [9].In the present study, all the papillary muscleswere measured for height, width and thickness. ConclusionMean height of PPM was 1.05 cm rangedbetween 0.3 cm to 3.3 cm, mean width was 0.6 The present study to understand the anatomy ofcm ranged between 0.2 cm to 1.2 cm and mean the constituent parts of the tricuspid valveInternational Archives of Integrated Medicine, Vol. 2, Issue 2, February, 2015. Page 36Copy right © 2015, IAIM, All Rights Reserved.

Morphometric study on posterior papillary muscles of tricuspid valve ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)complex not only helped examination of these 4. Gerola LR, Wafae N, Vieira MC, Julianoparts in cross sectional interrogation but also Y, Smith R, Prates JC. Anatomic study ofenhanced appreciation of valvular anomalies. the Tricuspid valve in children. SurgKnowledge regarding high variability of papillary Radiol Anat, 2001; 23: 149-53.muscles in the valve is helpful in corrective 5. Negri GR, Didio LJA, Baptista CAC.treatment of congenital disease like Ebstein’s Papillary muscles and tendinous chordsdisease and severe functional Tricuspid of the right ventricle of the human heartregurgitation. Any variation in the attachments morphological characteristics. Surgof muscle and their number, size and shape or Radiol Anat, 2001; 23: 45-9.their absence may cause prolapse of the leaflets. 6. Motabagani MAB. Comparative,Regurgitation is a consequence of deformity, morphometric and histological studiesshortening and retraction of one or more of the Tricuspid valve complex in humanleaflets of the Tricuspid valve as well as and some mammalian hearts. J Anat Socshortening and fusion of the papillary muscles India, 2006; 55(1): 1-23.[10]. 7. Begum JA, Khalil M, Rahman H, Adiluzzaman AA. A morphological andReferences morphometric study of the right ventricular papillary muscles of1. Standring S, Borley NR, Collins P, autopsied heart of Bangladeshi people. Crossman AR, Gatzoulis MA, Healy JC, et Mymensingh Medical Journal, 2006; al. Gray’s Anatomy: The Anatomical 15(2): 131-4. Basis of Clinical Practice. 40th edition. 8. Wafae N, Hayashi. H, Gerola LR, Vieira Philadelphia: Churchill Livingstone MC. Anatomical study of the human Elsevier; 2008, p. 966-7. Tricuspid valve. Surg Radiol Anat, 1990; 12: 37-41.2. Hashimoto K, Oshiumi M, Takakuva H, 9. Joudinaud TM, Flecher EM, Duran CMG. Sasaki T, Onoguchi K. Congenital mitral Functional terminology for the Tricuspid regurgitation from absence of the valve. J Hear Valve Dis, 2006; 15(3): 382- anterolateral papillary muscle. Ann 8. Thorac Surg, 2001; 72: 1386-7. 10. Ootaki Y, Yamaguchi M, Yoshimuva N, Oka S, Yoshida M, Hasegawa T. Tricuspid3. Balachandra N, Rathnam BPP. A Study of valve repair with papillary muscle the dimensions of the Human Tricuspid shortening for severe Tricuspid valve and attachment of chordae regurgitation in children. Ann Thorac tendinae. Surg, 2004; 78: 1486-8. http://www.rguhs.ac.in/digitallibrary/ha rdbibilo/medical-doc. Accessed on 20-7-2011.Source of support: Nil Conflict of interest: None declared.International Archives of Integrated Medicine, Vol. 2, Issue 2, February, 2015. Page 37Copy right © 2015, IAIM, All Rights Reserved.

Morphometric study on posterior papillary muscles of tricuspid valve ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)Table - 2: Comparison of measurements of posterior papillary muscles.Sr Studies No of cases Measurements of PPM (cm)No studied Mean height Mean width Mean thickness 0.5±0.11 Present study 96 1.05±0.4 0.6±0.2 --- ---2 Gerola LR, et al. [4] 50 0.9±0.2 0.7±0.23 Nigri GR, et al. [5] 79 1.1 ---International Archives of Integrated Medicine, Vol. 2, Issue 2, February, 2015. Page 38Copy right © 2015, IAIM, All Rights Reserved.