
As is shown in the study of 224 hearts with so-called mitral annular disjunction,1 the wheel has now come full circle. Although now usually credited to having first been seen by Henle as long ago as 1876, it was Hutchins and his colleagues who brought the feature to attention as a potential harbinger of pathological change.2 The investigators working at Johns Hopkins Hospital had noticed the anatomical arrangement in their investigation of over 900 hearts coming to autopsy, and being examined using a standardised technique. They defined the feature as ‘a wide separation between the atrium-valve junction and the atrial aspect of the left ventricular wall’. Although they had examined a very large number of hearts, they had ascertained the presence or absence of their chosen feature by taking a solitary section ‘at the level of the obtuse margin of the left ventricle’. Disjunction at their chosen site was found in 23 of 25 hearts with mitral valvar prolapse, but in only 37 of the 664 hearts they deemed to be normal. One of us was then involved in a more detailed study,3 in which we examined histologically the entirety of the atrioventricular junction supporting the mural leaflet of the mitral valve. We found disjunction, as defined by Hutchins et al,2 in similar proportions, and at similar sites, in both the hearts we studied with mitral valvar prolapse and the normal hearts. The group of morphologists working at the Jagiellonian University of Krakow, in Poland, have now extended their previous investigation of the normal mitral valve to assess the prevalence of such disjunction.1
As they comment, debates continue regarding the morphology of the mitral valvar complex, although to our eyes there is little difference in the accounts provided by the works they have referenced …
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- Source: http://heart.bmj.com/cgi/content/short/110/7/463?rss=1