Article Text

Download PDFPDF
Understanding the anatomy of the mitral valve: attitudinal is unnecessary
  1. Rebecca T Hahn
  1. Department of Medicine, Columbia University Medical Center, New York, New York, USA
  1. Correspondence to Dr Rebecca T Hahn, Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA; rth2{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

The controversy over the use of attitudinally correct nomenclature and morphological nomenclature for valvular structures has reached a peak with the rapid growth of transcatheter devices, positioned primarily by both echocardiography and fluoroscopy (figure 1A,B). Advocates of the attitudinal nomenclature propose that structures should be described as they lie within the body and as viewed in the anatomical position. This gross anatomical approach uses the body as the frame of reference. Standard cardiac nomenclature instead uses the heart as its own frame of reference. The original nomenclature of anterior and posterior mitral valve leaflets or lateral and medial mitral valve commissures is derived from the traditional ‘surgical view’ with the heart open in the chest, visualised standing to one side of the patient’s body. Although the proceduralist using fluoroscopy will sometimes image catheters moving within the body with the patient lying supine and with an anterior/posterior projection, the echocardiographer acquires transoesophageal echocardiographic (TOE) images from the oesophageal position, thus as if one was standing behind the patient (figure 1A,B). Positioning two-dimensional images from the mid-oesophageal imaging plane in the valentine view, with the left ventricle vertical and apex in the far-field of the image, optimises the physics of imaging for the mitral valve (ie, using axial resolution for leaflet morphological identification). With the use of three-dimensional (3D) …

View Full Text


  • Twitter @hahn_rt

  • Contributors RTH is the sole author of the manuscript, and the figures are original.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RTH reports speaker fees from Abbott Vascular, Baylis Medical and Edwards Lifesciences; institutional consulting for Abbott Structural, Edwards Lifesciences and Medtronic; and is Chief Scientific Officer for the Echocardiography Core Laboratory at the Cardiovascular Research Foundation for multiple industry-sponsored trials, for which she receives no direct industry compensation.

  • Provenance and peer review Commissioned; internally peer reviewed.

Linked Articles