Mitral Valve Repair Reference Center at The Mount Sinai Hospital Mount Sinai

Subvalvular apparatus of the mitral valve (Chordae tendinae and papillary muscles).
Subvalvular apparatus of the mitral valve (Chordae tendinae and papillary muscles).*

The chordae tendinae are the chord like structures connecting leaflets to the papillary muscle.


The chordae tendinae are primarily responsible for the end-systolic position of the anterior and posterior leaflets. Arising from the papillary muscles, they are classified according to their site of insertion between the free margin and the base of leaflets (Figure 1). Marginal chordae (primary chordae) are inserted on the free margin of the leaflets and function to prevent prolapse of the margin of the leaflet. Intermediate chordae (secondary chordae) insert on the ventricular surface of the leaflets and relieve valvular tissue of excess tension. They may also be important in preserving ventricular shape and function1, 2.  Basal chordae (tertiary chordae) are limited to the posterior leaflet and connect the leaflet base and mitral annulus to the papillary muscle.  The importance of maintaining the “connection” of the mitral leafets and annulus by chordae to the ventricle was well established in the early era of mitral valve replacement, when the entire valve apparatus was often excised, resulting in adverse ventricular shape and poorer over-all survival3.




(*) Modified from Carpentier A, Adams DH, Filsoufi F. Carpentier’s Reconstructive Valve Surgery. From Valve Analysis to Valve Reconstruction. 2010 Saunders Elsevier.

(1) Rodriguez F, Langer F, Harrington KB et al. Effect of cutting second-order chordae on in-vivo anterior mitral leaflet compound curvature. J Heart Valve Dis 2005 September;14(5):592-601.
(2) Rodriguez F, Langer F, Harrington KB et al. Importance of mitral valve second-order chordae for left ventricular geometry, wall thickening mechanics, and global systolic function. Circulation 2004 September 14;110(11 Suppl 1):II115-II122.
(3) David TE, Burns RJ, Bacchus CM, Druck MN. Mitral valve replacement for mitral regurgitation with and without preservation of chordae tendineae. J Thorac Cardiovasc Surg 1984 November;88(5 Pt 1):718-25.


Page Created: Wednesday, 10 May 2006

Last Updated: Wednesday, 21 September 2016


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