title: Physiologic remodeling annuloplasty to retain the shape of the anterior leaflet: a new concept in mitral valve repair.
abstract: OBJECTIVE
  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 ratio of which may be changed by sliding apart its two components.
  
  
  METHODS
  Remodeling annuloplasty was performed using part of a flexible Duran ring or autologous pericardium and the adjustable obturator in 17 patients with severe MR, including two with high anterior leaflet.
  
  
  RESULTS
  Physiologic remodeling annuloplasty was easily accomplished in all cases. Intraoperative echocardiography was performed in 14 patients, and it showed no regurgitant jet in 11 cases and only trivial jet in three.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kasegawa
authors.forename: S
authors.initials: S
authors.lastname: Kamata
authors.forename: T
authors.initials: T
authors.lastname: Ida
authors.forename: M
authors.initials: M
authors.lastname: Kawase
authors.forename: T
authors.initials: T
authors.lastname: Fujimoto
authors.forename: M
authors.initials: M
authors.lastname: Umezu
mesh_terms: D000328:Adult; D000368:Aged; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000502:physiology*; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome