The important of papillary muscles in geometry of the left ventricle

The two muscles (anterior and posterior) supporting the leaflets of the mitral valve also vary in length and breadth and may be bifid. The anterior muscle arises from the sternocostal mural myocardium; the posterior from the diaphragmatic region. Tendinous chordae arise mostly from the tip and apical third of each muscles but sometimes take origin near their base. The chordae from each papillary muscle diverge and are attached to the corresponding areas of closure on both valvular leaflets. The anterior papillary support had 1 and 5 bellies. Likewise, the posterior papillary support had 1-4 muscle bellies. The single bellied papillary muscles were conical, mammillated, flat topped, grooved, stepped, arched or sloped. Two bellied muscles might present as a two interlinked, parallel, arched, V,Y,H configuration. The insertio angulus of musculus papillary varied between 20 degrees and 55 degrees. Presentation of the annula-papillary muscle continuty in mitral valve replacement is important. Even in patients who require excision of the mitral apparatus, the continuty can be restored. The mitral subvalvular apparatus is important to attain the integrity of the left ventricular geometric model and systolic pump function of the heart.