**4. Etiology**

6 Front Lines of Thoracic Surgery

Fig. 3. Mitral apparatus. ALPM, Anterolateral papillary muscle; PMPM, posteromedial papillary muscle; AoL, aortic leaflet; Ant.Com.L., anterior commissural leaflet; Post.Com.L., posterior commissural leaflet; Ant.Scal. , anterior scallop; Mid.Scal ., middle scallop; h, height of a leaflet; l, length of the attachment of a leaflet; Post.Scal. , posterior scallop; Rt. Trigone, right fibrous trigone; Lt. Trigone, left fibrous trigone; 1, anterior main chorda; 2, posterior main chorda; 3, anterior paramedial chorda; 4, posterior paramedial chorda; 5, anterior paracommissural chorda; 6, posterior paracommissural chorda; 7, anterior commissural chorda; 8, posterior commissural chorda; 9, anterior cleft chorda; 10, posterior cleft chorda.

Today, multiple terminologies used to describe mitral pathology. Terms such as prolapse, flail, partial flail, redundant, overshooting, stretching, elongation, floppy, billowing, ballooning, Barlow, dysplasia, myxoid, and myxomatous, for example, have different meanings for different specialists. The confusion comes first from the fact that several of these terms are synonyms. For example, flail leaflet, overshooting leaflet and leaflet prolapse are synonyms. Other synonyms are Barlow, billowing, ballooning, myxomatous valve, and mitral valve prolapse. Another source of confusion comes from the fact that for some specialists a given term such as « prolapse» means a disfunction (leaflet prolapsed) while for others it refers to a disease (mitral valve prolapse). The same chaotic situation applies to the term « floppy valve», which is used to define either a valve morphology, or dysfunction, or a disease. Similar confusion exists in tricuspid and aortic valve diseases, in which many of previously listed terms are used without clear distinction. Clarification can be obtained by using a pathophysiological triad with a sound distinction between the terms describing valve etiology (i.e., the cause of the disease), valve lesions resulting from the disease, and

**Etiology - The cause of the disease**  ↓ **Lesions - Result from the disease**  ↓ **Dysfunction - Result from the lesions**  The pathophysiological triad facilitates communication between cardiologists,

echocardiographers and surgeons and greatly clarifies clinical investigation.

**3. Pathophysiology** 

valve dysfunction resulting from the lesions.

Cardiac valves can be affected by numerous disease (Tab # 1). Primary valve disease involve the valvular tissue. Secondary valve disease affect the supporting of the valves – that is, the ventricles for the mitral and tricuspid valves and the aorta and pulmonary artery for the aortic and pulmonary valves, respectively. The determination of the etiology of valvular disease is important because it helps to establish the medical treatment, which should precede or follow valve reconstruction.


Table 1. Etiology of valvular disease.
