The Embryonic story of Mr. Aortic and Ms Mitral
Ashley Davidoff
The attraction of Mr. Aortic to Ms Mitral
goes back a long long way
As far back as fetal times –
and in fact even beyond in evolution
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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 above the right ventricle
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
Miss Pulmonary with her chosen right ventricle while
He and Ms Mitral with the Left ventricle
Mr Aorta only has eyes for Ms Mitral
How is Mr Aorta going to reach her?
Double Outlet RV Morphology
Ashley Davidoff MD 2018
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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 (the heart).
He did have a chance with her twin Ms Tricuspid
She was pretty too
But Miss Mitral was the twinkle of his eye
Since her flap was in synch with his
Resorption of the subaortic conus brings Mr Aorta (the aortic valve) toward Ms Mitral (the mitral valve)
Ashley Davidoff MD 2018
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And on a glorious day one summer
They bonded in fibrous union
In ecstasy they danced together
And never could be parted
Ashley Davidoff MD 2018
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From then on they lived their life
In a beautiful pulsatile glory
She gave him all that she received
and he in turn delivered
Ashley Davidoff MD 2018
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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.
Ashley Davidoff MD 2018
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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
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.
Ashley Davidoff MD 2018
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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 Marfan’s syndrome
Ashley Davidoff MD 2018
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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