[Medical Illustration Explanation] How to Connect Pathophysiology and Surgical Procedures

■ Overview
Medical Education Co., Ltd. (Suginami-ku, Tokyo, Representative: Takashi Ochiai) has released a Figure design case study on papillary muscle relocation for mitral regurgitation.

This case study was designed from the perspective of how to organize and visualize the complex pathophysiology associated with a left ventricular aneurysm and the multiple surgical procedures performed for it, so that it can be communicated to a third party without misunderstanding.

Case reports and surgical procedure papers need to convey not only the understanding of the pathophysiology but also the relationship between "which pathophysiology corresponds to which procedure." However, in cases where pathophysiology progresses sequentially and multiple procedures are combined, it is not easy to grasp the correspondence at a glance.

This release introduces the design decisions made to organize complex pathological chains and surgical interventions and structure them into a single Figure.

Target Audience

- Researchers designing Figures for surgical papers
- Physicians facing challenges in illustrating case reports
- Editors and production staff involved in visual production in the medical and academic fields

■ Case Example (Source Information)

This case study targets a Figure created in relation to the following case report.

Paper Title: Papillary muscle relocation for mitral regurgitation attributable to flail but tethered commissure associated with a left ventricular aneurysm

Journal: JTCVS Techniques

Authors: Hiromitsu Teratani, Kiyoyuki Eishi, Kikuko Obase, Yuko Nakao, Kazuki Hisatomi, Takashi Miura

DOI: https://doi.org/10.1016/j.xjtc.2025.102166

This Figure was produced by Medical Education Co., Ltd. (MEDICAL FIG.) with the aim of schematically organizing the relationship between preoperative pathophysiology and surgical procedures in the same case.

It presents the preoperative pathophysiology due to papillary muscle displacement and chordae tendineae rupture associated with a left ventricular aneurysm, and organizes the procedures of papillary muscle resection, papillary muscle relocation, and edge-to-edge suture, allowing for a visual grasp of the correspondence between pathophysiology and procedures.

A Figure that schematically organizes the preoperative pathophysiology due to papillary muscle displacement and chordae tendineae rupture associated with a left ventricular aneurysm, and the procedures of papillary muscle resection, approximation of papillary muscle heads, and edge-to-edge suture in stages. The configuration allows for a visual grasp of the correspondence between pathophysiology and procedures.

■ Why is this case difficult to understand?

In this case, starting from the change in ventricular morphology due to the formation of a left ventricular aneurysm:

- Papillary muscle displacement
- Cusp tethering
- Chordae tendineae rupture
- Cusp coaptation failure

occurred sequentially, ultimately presenting as mitral regurgitation.

In other words, multiple pathologies do not exist independently; one pathological change leads to the next.

On the surgical side, different interventions are performed for each pathology.

Papillary muscle resection and papillary muscle relocation aim to improve displaced papillary muscles and cusp tethering, while edge-to-edge suture is performed to compensate for cusp coaptation failure.

Therefore, organizing and communicating the relationship "which procedure corresponds to which pathophysiology" became a significant challenge in Figure design for this case.

■ How to Organize Pathological Chains and Intervention Points

The following challenges were set for Figure design:

- How to organize the pathological chain
- What granularity to break down surgical procedures into
- How to correlate pathophysiology and intervention points
- How to control the reader's cognitive load

In this case, the design focused not only on "what to draw" but also on "in what order the reader should understand it."

■ Four Decisions Made in Figure Design

1. Fixing the Pathological Structure

The positional relationship of the papillary muscles and valve structures is shown in the left diagram, explicitly fixing the spatial structure of the pathophysiology.

This allows readers to understand the structure of the pathophysiology itself before following individual procedures.

2. Decomposing the Pathological Chain

The progression of pathophysiology from left ventricular aneurysm formation to mitral regurgitation was organized.

This structure encourages understanding of "how the current state was reached through causal relationships" rather than simply presenting the pathophysiology as a result.

3. Explicitly Correlating Pathophysiology and Procedures

Procedures are not simply listed as surgical steps, but rather:

- Papillary muscle resection/relocation → Intervention for papillary muscle displacement/tethering

- Edge-to-edge suture → Intervention for cusp coaptation failure

They are arranged to show the correspondence with the pathophysiology.

This allows readers to understand not only "what was done" but also "why that operation was necessary."

4. Emphasizing Structural Differences through Visual Representation

To clearly show the decomposition of the pathological chain:

- Color differences
- Boundary lines
- Contrast

were used to emphasize structural differences. The goal is to make important pathological changes visually recognizable.

■ Information Deliberately Omitted

In this case, controlling cognitive load was prioritized over increasing the amount of information.

Specifically:

- Information on structures not subject to operation was simplified.
- Information with little relevance to the main subject was deleted.
- Structural understanding was prioritized over physiological details.

In Figure production, "what not to draw" is as important as "what to draw."

■ What This Case Demonstrates

This Figure is not merely an auxiliary diagram for case explanation.

It is an example of reconstructing complex medical information into a communicable form by decomposing the pathological chain from left ventricular aneurysm formation to mitral regurgitation and correlating each with surgical intervention.

This case also demonstrates design principles applicable to case reports and surgical procedure papers in general:

- Organize pathophysiology as a chain, not just a result.
- Decompose procedures into functional units.
- Correlate pathophysiology and intervention points.
- Control cognitive load, not information volume.

Medical Education Co., Ltd. specializes in the design domain of "how to communicate research results," rather than the research content itself, and supports information visualization in case reports, surgical procedures, and academic materials.

■ About Medical Education Co., Ltd. / MEDICAL FIG.

Medical Education Co., Ltd. (SCICUS Group Co., Ltd.) supports the organization of thought and structural visualization for researchers and specialists in the fields of medicine, life sciences, and healthcare.

Through the production of paper Figures, Graphical Abstracts, Central Illustrations, and surgical procedure diagrams, MEDICAL FIG. designs the communication of research results and clinical knowledge.

■ Contact Information

Medical Education Co., Ltd.

Corporate Site
https://www.medicaleducation.co.jp/

Inquiry Form
https://www.medicaleducation.co.jp/inqu