This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by ROBERTS, W. C. Articles by COHEN, L. S. Search for Related Content PubMed PubMed Citation Articles by ROBERTS, W. C. Articles by COHEN, L. S.

(Circulation. 1972;46:138.)
© 1972 American Heart Association, Inc.

---

Left Ventricular Papillary Muscles

Description of the Normal and a Survey of Conditions Causing them to be Abnormal

WILLIAM C. ROBERTS M.D.¹ LAWRENCE S. COHEN M.D.¹

¹ From the Section of Pathology and the Cardiology Branch, National Heart and Lung Institute, National Institutes of Health, Bethesda, Maryland.

The left ventricular papillary muscles appear to be the last portions of the heart to be perfused by coronary arterial blood. As a consequence they are sensitive anatomic markers of myocardial ischemia. Foci of necrosis or fibrosis therefore are commonly seen in these structures, particularly the posteromedial papillary muscle, which has a poorer blood supply than does the anterolateral muscle. Coronary arterial luminal narrowing is the most common cause of necrosis or fibrosis of the left ventricular papillary muscles. Other conditions, all associated with inadequate cardiac output, which may produce these lesions include left ventricular outflow tract obstruction, especially that resulting from congenitally malformed aortic valves, acute valvular regurgitation (infective endocarditis), various cardiomyopathies, and primary endocardial fibroelastosis with or without anomalous origin of one or both coronary arteries from the pulmonary trunk. Various infiltrative diseases, including inflammation (Aschoff bodies, sarcoid, abscesses), amyloid, iron, and neoplasms, also may involve the papillary muscles. Their most common congenital malformation is the parachute or single papillary muscle. Fibrosis or necrosis of adjacent left ventricle free wall without involvement of the papillary muscles themselves may simulate clinically "papillary muscle dysfunction." The anterior papillary muscle of the right ventricle is frequently affected by conditions which also affect the left ventricular papillary muscles. Whether or not necrosis or fibrosis of the right ventricular papillary muscle causes tricuspid regurgitation, however, is unknown at present.

Key Words: Coronary heart disease • Congenital heart disease • Myocardial infarction • Aortic stenosis • Idiopathic cardiomegaly • Cardiac surgery

Submitted on January 10, 1972
Accepted on February 7, 1972

This article has been cited by other articles:

				W. Y. Szeto, R. C. Gorman, J. H. Gorman III, and M. A. Acker Ischemic Mitral Regurgitation Card. Surg. Adult, January 1, 2008; 3(2008): 785 - 802. [Full Text]

				C. J. Francois, D. S. Fieno, S. M. Shors, and J. P. Finn Left Ventricular Mass: Manual and Automatic Segmentation of True FISP and FLASH Cine MR Images in Dogs and Pigs Radiology, February 1, 2004; 230(2): 389 - 395. [Abstract] [Full Text] [PDF]

				D. L.-M. Wiegand Advances in Cardiac Surgery: Valve Repair Crit. Care Nurse, April 1, 2003; 23(2): 72 - 90. [Full Text] [PDF]

				R. C. Gorman, J. H. Gorman III, and L. H. Edmunds Jr. Ischemic Mitral Regurgitation Card. Surg. Adult, January 1, 2003; 2(2003): 751 - 769. [Full Text]

				M. L. McDonald, T. A. Orszulak, M. P. Bannon, and S. P. Zietlow Mitral Valve Injury After Blunt Chest Trauma Ann. Thorac. Surg., March 1, 1996; 61(3): 1024 - 1029. [Abstract] [Full Text]