A Marriage Made In Heaven –

The story of Mr. Aortic and Miss Mitral

 Ashley Davidoff MD Copyright 2007

The attraction of Mr. Aortic to Miss Mitral

goes back a long long way

As far back as fetal times –

and in fact even beyond in evolution

 

Aorta and Pulmonary Artery Side by Side

01806 heart cardiac bilateral conus outflow tract infundibulum aorta pulmonary artery D-loop anatomy embryology Courtesy Ashley Davidoff drawing

 

When the valve of Mr. Aortic eyed the developing Miss Mitral

He knew from that moment and on

That she was to be his bride

And that no other would come between them

He had to leave his fetal home

A throne shared with his twin Miss Pulmonary

And he knew that they would now move in different circles

Each to go their own way

 

Ms Mitral in Pink

06370a02 heart cardiac bilateral conus outflow tract infundibulum aorta pulmonary artery D-loop RV LV conoventricular defect bilateral conus atrioventricular endocardial cushion mitral valve anatomy embryology subaortic conus subpulmonary conus fibrous continuity mitral valve MV Courtesy Ashley Davidoff Davidoff drawing

 

Ms Mitral Looking More Attractive How is Mr Aorta Going to Reach Her

07427b10 heart cardiac bilateral conus outflow tract infundibulum aorta pulmonary artery D-loop RV LV conoventricular defect anatomy embryology subaortic conus subpulmonary conus fibrous continuity anterior leaflet posterior leaflet of the mitral valve MV Courtesy Ashley Davidoff Davidoff drawing

 

 

Resorbtion of the Subaortic Conus Allows Mr Aorta to get Close to Ms Mitral

06370b03 heart cardiac bilateral conus outflow tract infundibulum aorta pulmonary artery D-loop RV LV conoventricular defect bilateral conus atrioventricular endocardial cushion mitral valve anatomy embryology subaortic conus subpulmonary conus fibrous continuity mitral valve MV Courtesy Ashley Davidoff Davidoff drawing

 

His mission was unrelenting

As he continued down on his trip

Her anterior leaflet was his goal

As he flapped to the Lub of his master

He had a chance with her twin Tricuspid

She was pretty too

But Miss Mitral was the twinkle of his eye

Since her flap was in synch with his

And on a glorious day one summer

They bonded in fibrous union

In ecstasy they danced together

And never could be parted

Bonding in Fibrous Union

07427b02 heart cardiac bilateral conus outflow tract infundibulum aorta pulmonary artery D-loop RV LV conoventricular defect anatomy embryology subaortic conus subpulmonary conus fibrous continuity anterior leaflet posterior leaflet of the mitral valve MV Courtesy Ashley Davidoff Davidoff drawing

From then on they  lived their life

In a beautiful pulsatile glory

She gave him all that she received

and he in turn delivered –

Working together During an Angiogram code cardiac heart MV anterior leaflet posterior leaflet normal anatomy physiology systole 34814 imaging radiology angiography normal overlay     Working Together to Form an Inflow and an Outflow to teh Left Ventricle The mitral valve participates in the inflow as well as the outflow of the LV. The LV does not have an infundibular chamber like the RV. It is the anterior leaflet of the MV that has this dual function. The first drawing represents LV diastole, showing the open anterior leaflet acting as the anterior, medial and rightward border of the inflow to the LV. The second drawing is the systolic phase where this same anterior leaflet acts as the leftward and lateral border of the outflow tract. Courtesy of Ashley Davidoff M.D. 32119b01   And through many years they worked hard in harmony Toward a greater strength for the whole Together they produced One million beats and a volume of enormous score   Nothing could separate this bonded union ‘cept the disease that wreaked its havoc And in the end the disease of  him affected her greatly too     IHSS – Left Ventricular Muscular Obstruction with Mitral Regurgitation This angiogram in RAO projection shows a hypercontractile left ventricle that has a ballet shoe appearance, with mitral regurgitation filling the left atrium. The drawing shows the significant LVH small cavity of the LV, the area of subaortic muscle bundle (green) and the mitral regurgitation caused by the systolic anterior motion of the mitral valve. Courtesy Ashley Davidoff 34805 cardiac heart MV interventriclar septum LVH IHSS SAM MR imaging radiology angiography disease overlay   Prolapse of the Mitral Valve and Aortic Regurgitation  – Marfan’s Syndrome This angiogram in RAO projection shows prolapse of both the anterior and posterior leaflets of the mitral valve with mitral regurgitation. Note also the bulbous appearance of the aortic sinuses. The back wall of the left atrium is flattened against the spine suggesting a narrow A-P diameter or pectus excavatum. These findings are characteristic of Maran’s syndrome Courtesy Ashley DAvidoff MD. 34810c code cardiac heart mitral valve MV anterior leaflet posterior leaflet prolapse mitral regurgitation MR incompetence aorta Marfan’s syndrome floppy mitral valve angiography LA shape MVP imaging radiology angiography disease overlay radiologists and detectives   Aged and happy they so declined Still beating to the same drum And they were of course happily assured That their beat would repeat … in the next of kin