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Inelastic cords of fibrous connective tissue connecting papillary muscles to heart valves
The chordae tendineae (
sg. : chorda tendinea ) or tendinous cords , colloquially known as the heart strings , are inelastic cords of
fibrous connective tissue that connect the
papillary muscles to the
tricuspid valve and the
mitral valve in the
heart .
[1]
[2]
Structure
The chordae tendineae connect the
atrioventricular valves (
tricuspid and
mitral ), to the
papillary muscles within the
ventricles .
[2] Multiple chordae tendineae attach to each
leaflet or cusp of the valves.
[3] Chordae tendineae contain
elastin in a delicate structure notably at their periphery.
[4]
Tendon of Todaro
The tendon of Todaro is a continuation of the
Eustachian valve of the inferior vena cava and the
valve of the coronary sinus . Along with the opening of the coronary sinus and the
septal cusp of the tricuspid valve, it makes up
Koch's triangle . The apex of Koch's triangle is the location of the
atrioventricular node .
[5]
Function
A medical illustration showing a cross section of the heart and lungs, chordae tendineae visible.
During
atrial systole, blood flows from the atria to the ventricles down the
pressure gradient . Chordae tendineae are relaxed because the
atrioventricular valves are forced open.
[6]
When the
ventricles of the heart contract in ventricular systole, the increased
blood pressures in both chambers push the AV valves to close simultaneously, preventing backflow of blood into the
atria . Since the blood pressure in atria is much lower than that in the ventricles, the flaps attempt to evert to the low pressure regions. The chordae tendineae prevent this
prolapse by becoming tense, which pulls on the flaps, holding them in closed position.
[6]
Clinical significance
Ruptured chordae tendineae
Valvular heart disease can lead to ruptured chordae tendineae.
[7] This can cause severe
mitral insufficiency .
[7]
[8]
Parachute mitral valve
Parachute mitral valve occurs when all the chordae tendineae of the mitral valve attach to a single papillary muscle.
[9]
[10]
[11] This causes
mitral valve stenosis at an early age.
[10] It is a rare
congenital heart defect .
[11] Although it often causes
mitral insufficiency , it may not present any
symptoms .
[10]
Additional images
See also
References
^ Hacking, Craig.
"Chordae tendineae | Radiology Reference Article | Radiopaedia.org" . Radiopaedia .
^
a
b Faletra, Francesco F.; Narula, Jagat (2017-01-01), Ellenbogen, Kenneth A.; Wilkoff, Bruce L.; Kay, G. Neal; Lau, Chu-Pak (eds.),
"2 - Imaging of Cardiac Anatomy" , Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy (Fifth Edition) , Elsevier, pp. 15–60,
doi :
10.1016/b978-0-323-37804-8.00002-x ,
ISBN
978-0-323-37804-8 , retrieved 2020-11-25
^ Lane, Rondall; Schulman, Peter M. (2007-01-01), Parsons, Polly E.; Wiener-Kronish, Jeanine P. (eds.),
"Chapter 30 - Valvular Heart Disease" , Critical Care Secrets (Fourth Edition) , Philadelphia: Mosby, pp. 191–199,
doi :
10.1016/b978-1-4160-3206-9.10030-8 ,
ISBN
978-1-4160-3206-9 , retrieved 2020-11-25
^ Green, EM; Mansfield, JC; Bell, JS; Winlove, CP (2014-04-06).
"The structure and micromechanics of elastic tissue" . Interface Focus . 4 (2): 20130058.
doi :
10.1098/rsfs.2013.0058 .
PMC
3982448 .
PMID
24748954 .
^ McGuire, Mark A.; Johnson, David C.; Robotin, Monica; Richards, David A.; Uther, John B.; Ross, David L. (1992-09-15).
"Dimensions of the triangle of Koch in humans" . The American Journal of Cardiology . 70 (7): 829–830.
doi :
10.1016/0002-9149(92)90574-I .
ISSN
0002-9149 .
PMID
1519544 .
^
a
b Karas, S.; Elkins, R. C. (1970).
"Mechanism of Function of the Mitral Valve Leaflets, Chordae Tendineae and Left Ventricular Papillary Muscles in Dogs" . Circulation Research . 26 (6): 689–96.
doi :
10.1161/01.RES.26.6.689 .
PMID
5422929 .
^
a
b Vaideeswar, P.; Butany, J. (2016-01-01), Buja, L. Maximilian; Butany, Jagdish (eds.),
"Chapter 12 - Valvular Heart Disease" , Cardiovascular Pathology (Fourth Edition) , San Diego: Academic Press, pp. 485–528,
ISBN
978-0-12-420219-1 , retrieved 2020-11-25
^ Reece, T. Brett; Fullerton, David A. (2009-01-01), Harken, Alden H.; Moore, Ernest E. (eds.),
"Chapter 76 - Mitral Regurgitation" , Abernathy's Surgical Secrets (Sixth Edition) , Philadelphia: Mosby, pp. 387–390,
doi :
10.1016/b978-0-323-05711-0.00076-8 ,
ISBN
978-0-323-05711-0 , retrieved 2020-11-25
^ Llewelyn, Rhys.
"Parachute mitral valve | Radiology Reference Article | Radiopaedia.org" . Radiopaedia .
^
a
b
c Boutsikou, Maria; Li, Wei (2018-01-01), Gatzoulis, Michael A.; Webb, Gary D.; Daubeney, Piers E. F. (eds.),
"6 - Echocardiography" , Diagnosis and Management of Adult Congenital Heart Disease (Third Edition) , Elsevier, pp. 41–76,
doi :
10.1016/b978-0-7020-6929-1.00006-x ,
ISBN
978-0-7020-6929-1 , retrieved 2020-11-25
^
a
b Tay Lik Wui, Edgar; Yip, James W. L.; Li, Wei (2011-01-01), Gatzoulis, Michael A.; Webb, Gary D.; Daubeney, Piers E. F. (eds.),
"5 - Echocardiography" , Diagnosis and Management of Adult Congenital Heart Disease (Second Edition) , Saint Louis: Churchill Livingstone, pp. 28–43,
doi :
10.1016/b978-0-7020-3426-8.00005-8 ,
ISBN
978-0-7020-3426-8 , retrieved 2020-11-25
^
"UOTW #75 - Ultrasound of the Week" . Ultrasound of the Week . 4 November 2016. Retrieved 27 May 2017 .
General
Chambers
Layers
Blood supply