PHYSIOLOGICAL REMODELING ANNULOPLASTY TO RETAIN THE SHAPE OF THE ANTERIOR LEAFLET - A NEW CONCEPT IN MITRAL-VALVE REPAIR

Background and aims of the study: The Carpentier-Edwards (CE) ring was developed to restore the normal 3:4 ratio between the anteroposterior and transverse diameters of the mitral valve orifice during systole. It is difficult to use in patients in whom the ratio is more than 3:4. To overcome this problem, we developed an adjustable obturator, the r atio of which may be changed by sliding apart its two components. Meth ods: Remodeling annuloplasty was performed using part of a flexible Du ran ring or autologous pericardium and the adjustable obturator in 17 patients with severe MR, including two with high anterior leaflet. Res ults: Physiologic remodeling annuloplasty was easily accomplished in a ll cases. Intraoperative echocardiography was performed in 14 patients , and it showed no regurgitant jet in 11 cases and only trivial jet in three. Conclusion: Physiologic remodeling annuloplasty to retain the natural shape of the anterior leaflet by using an adjustable obturator is a very useful technique that enables annuloplasty to be performed in all cases, irrespective of the shape of the anterior leaflet.