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Fig. 6.12b. Annuloplasty. The trigones are identified by traction on the anterior leaflet. The distance between the trigones indicates the appropriate Duran ring size. Four nonplegetted sutures are placed on the anterior (septal) annulus. Six sutures are placed on the posterior (mural) annulus. For the anterior 4 sutures, the intrasuture distance [A] and intersuture distance [B] is the same on the annulus and Duran ring. For the posterior 6 sutures, the intrasuture distance [A] is greater on the annulus than on the Duran ring. This will tighten a dilated annulus. The intersuture distance [B] is the same on the annulus and Duran ring.

Fig. 6.12b. Annuloplasty. The trigones are identified by traction on the anterior leaflet. The distance between the trigones indicates the appropriate Duran ring size. Four nonplegetted sutures are placed on the anterior (septal) annulus. Six sutures are placed on the posterior (mural) annulus. For the anterior 4 sutures, the intrasuture distance [A] and intersuture distance [B] is the same on the annulus and Duran ring. For the posterior 6 sutures, the intrasuture distance [A] is greater on the annulus than on the Duran ring. This will tighten a dilated annulus. The intersuture distance [B] is the same on the annulus and Duran ring.

Duran Ring

Fig. 6.12c. Quadrangular excision of the posterior leaflet of the mitral valve. Resection of the posterior leaflet containing the ruptured chordae is performed. Plegetted sutures are used to plicate the annu-lus. The leaflet is repaired with interrupted 5-0 Prolene. A Duran annuloplasty ring is used to reinforce the repair.

Fig. 6.12d. Chordal shortening. Plegetted 4-0 Prolene is used to plicate the muscle head with the redundant chordae. Alternately, a suture is used to wrap the redundant chorda and plicate it to the papillary muscle.

TRICUSPID VALVE DISEASE

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