Mitral valve disease is the most common valvular disorder encountered in clinical practice¹. The Valve morphology and functionality are altered by congenital anomalies, such as mitral valve prolapse, or acquired through age-related degenerative changes, i.e., stenosis2. Surgical management with valve replacement is the current standard of care in the above clinical conditions.

In the recent era, mechanical valves and biological substitutes, such as homo grafts, auto grafts, and hetero grafts, are available3. Knowledge of morphometric data of valves among the different populations, age, and gender is required for the prosthetic designing. Considering the complexity of mitral valve, cadaver-based research findings are remarkable in comparison with recent developments such as CT, MRI or echocardiographic findings. The knowledge gained from cadaveric morphometric studies helps in clinical diagnosis of cases in correlation with the radiographic findings. The aim of our present study was to analyze the morphometric of mitral valve by measuring its annular circumference, length and height of anterior and posterior leaflets of cadavers.

MATERIALS AND METHODS

The present study was conducted on 50 isolated, formalin-fixed human hearts obtained from adult cadavers in the Department of Anatomy, Father Muller Medical College, Mangalore. Hearts from adult cadavers without any gross morphological abnormalities were included in the study.

All specimens were thoroughly washed under running water to remove residual blood clots and debris. The left atrium and left ventricle were opened by making a lateral incision along the left border of the heart using a scalpel, thereby adequately exposing the interior of the chambers for proper visualization of the mitral valve leaflets.

Morphometric measurements were obtained using a cotton thread and a measuring ruler. The following parameters were assessed and all measurements were recorded in centimeters.

• Annular circumference (C): Measured at the base of the mitral valve leaflets by placing the cotton thread along the boundary of the annulus and adjusting it to conform to its
• Length of the anterior and posterior mitral valve leaflets: Measured along the annular
• Height of each leaflet: Measured from the base to the free edge along the central axis of the leaflet.

Statistical Analyses

Descriptive statistical analysis was performed for all parameters, and the results were expressed as mean ± standard deviation (SD)

RESULTS

Table 1: Morphometric measurements of mitral valve leaflets and annular circumference (n =50)

The mean length of the anterior leaflet was 3.51 ± 0.68 cm, while that of the posterior leaflet was 4.46 ± 0.91 cm. The mean height of the anterior and posterior leaflets measured 2.03 ± 0.32 cm and 1.16 ± 0.29 cm, respectively.

The mitral annular circumference ranged from 8.40 cm to 15.60 cm, with a mean value of 9.29 ± 1.28 cm. The length of the anterior leaflet ranged from 3.40 cm to 5.40 cm, and its height ranged from 1.20 cm to 2.50 cm.

Table 2: Comparison of mitral valve leaflet dimensions and annular circumference with previous studies

Pic 1: Showing the length (L) & Height (H) of the leaflet

Pic 2: Measuring the annular circumference

DISCUSSION

The cadaveric studies delineate the true anatomical relationships, dimensions, and variations of complex cardiac structures such as the mitral valve²,³. The results from the studies from various geographical areas helps in the analysing the computational imaging studies for clinicians.

The present study offers detailed morphometric characterization of the mitral valve leaflets and annulus, placing these findings in the context of previously published data (Tables 1 and 2). The results demonstrate a clear geometric asymmetry between the anterior and posterior leaflets: the posterior leaflet exhibited a greater mean length (4.46 ± 0.91 cm) compared to the anterior leaflet (3.51 ± 0.68 cm), whereas the anterior leaflet was taller (2.03 ± 0.32 cm vs. 1.16 ± 0.29cm)⁶⁻⁸.

The elongated posterior leaflet provides enhanced annular coverage during systole and the taller anterior leaflet contributes to effective co aptation and resistance to left ventricular pressures⁶,⁷. Comparable patterns have been consistently reported in previous cadaveric and imaging-based studies⁶,⁷,⁹.

The mean annular circumference in this study (9.29 ± 1.28 cm) aligns closely with values reported by Padhy et al.³, Gunnal et al.⁷. The discrepancies between studies can be attributed to the differences in specimen preservation, measurement landmarks, and inclusion criteria

These morphometric data have direct clinical and translational implications, including mitral valve repair, prosthetic valve design, annuloplasty ring selection, imaging interpretation, and trans catheter interventions. Accurate knowledge of leaflet dimensions and annular circumference is essential for procedural planning, minimizing patient–prosthesis mismatch, and ensuring optimal surgical and device outcomes⁶,⁷,¹⁰.

Strengths and Contribution to Literature

A key strength of this study is its systematic morphometric assessment and comprehensive comparison with existing literature. The consistency of findings reinforces the anatomical validity of the results and enhances their translational applicability. This work provides a reliable reference for both clinical and research purposes, supporting anatomically informed approaches in mitral valve interventions.

CONCLUSION

This study provides high-quality morphometric data on mitral valve leaflets and annular circumference that are concordant with and additive to existing literature. The observed structural asymmetry and dimensional variability support patient-specific, anatomically driven approaches in surgical and interventional cardiology. These data serve as a valuable baseline reference for diagnostic evaluation, surgical planning, and the development of next-generation mitral valve devices.

REFERENCES

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