Surgical anatomy of the mitral valve

Introduction: The gold standard for mitral valve disease is surgical treatment, for which it is essential to have a deep understanding of its anatomy. Our work aims to specify the relationships of the mitral annulus with the circumflex artery and define areas of proximity and greater risk of compromise during mitral interventions. Material and methods: A descriptive, observational, cross-sectional study was conducted, in which 39 hearts from adult cadavers fixed in formaldehyde solution were dissected. From an atrial view of the mitral valve, taking the mitral annulus as a reference, several measurements were taken using Carpentier ́s classification of the sectors of the posterior mitral valve (P1, P2, and P3). Distance 1: from the anterolateral commissure to the circumflex artery. Distance 2: from the middle third of P1 to the artery. Distance 3: from P2 to the artery. Distance 4: from P3 to the artery.Results: The global mean of distance 1 was 8.38 mm, of distance 2 was 8.16 mm, of distance 3 was 7.09 mm, and of distance 4 was 7.97 mm. We found no statistically significant differences according to coronary dominance. Conclusion: The area of highest risk of injury to the circumflex artery concerning to the mitral annulus corresponds to the P2 sector of the posterior mitral leaflet. Left dominance and codominance would be associated with a greater risk.