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April 15, 1968

The Papillary Muscle Syndrome

Author Affiliations

From the Department of Medicine of the Tulane University School of Medicine, the Charity Hospital of Louisiana, and the Veterans Administration Hospital, New Orleans.

JAMA. 1968;204(3):249-252. doi:10.1001/jama.1968.03140160059016

Normal mitral valve function is dependent upon several structures other than the valve leaflets alone. These structures are in anatomic continuity from the atrial muscle to the ventricular muscle and, in addition to the leaflets, include the valve ring, the chordae tendineae, conduction tissue, and the papillary muscles. For perfectly normal valve function, each of these structures must be (1) anatomically and functionally intact, (2) in appropriate spatial interrelationship, and (3) operative in correct temporal sequence with respect to related structures.

Obviously, normal mitral valve function is dependent upon a rather complex and finely coordinated system. In the past, of all the structures in this system, the papillary muscles have received the least interest and study. Yet they are of paramount importance, and disturbances of their function are a common cause of mitral valve incompetence.

Pathophysiology  Causes of papillary muscle dysfunction may be outlined as follows:Circulatory insufficiency (ischemia)Angina