Is Physiologic Annular Dynamics Preserved After Mitral Valve Repair With Rigid or Semirigid Ring? Masaaki Ryomoto, MD, PhD, Masataka Mitsuno, MD, PhD,

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Is Physiologic Annular Dynamics Preserved After Mitral Valve Repair With Rigid or Semirigid Ring? Masaaki Ryomoto, MD, PhD, Masataka Mitsuno, MD, PhD, Mitsuhiro Yamamura, MD, PhD, Hiroe Tanaka, MD, Shinya Fukui, MD, PhD, Noriko Tsujiya, MD, Tetsuya Kajiyama, MD, Yuji Miyamoto, MD, PhD The Annals of Thoracic Surgery Volume 97, Issue 2, Pages 492-497 (February 2014) DOI: 10.1016/j.athoracsur.2013.09.077 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Annular modeling. (A) Thirty-six markers around the annulus were marked on 18 rotational planes (green lines). The mitral annulus was expressed as the yellowish line. The dashed line shows the anteroposterior diameter and the continuous line shows the commissure-to-commissure diameter. (B) Three-dimensional structured view of the mitral annulus. The dotted line shows the annular height, which was measured between the highest and lowest points of the mitral annulus. (A = anterior; AL = anterolateral; P = posterior; PM = posteromedial.) The Annals of Thoracic Surgery 2014 97, 492-497DOI: (10.1016/j.athoracsur.2013.09.077) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Postoperative anteroposterior (AP) diameter reduction rates throughout a cardiac cycle. The postoperative anteroposterior diameter reduction rate from end diastole to end systole is significantly higher in the MEMO ring compared with the Physio II and RSR rings. The value in the MEMO ring is equivalent to the normal control value. Data are mean ± SD (*p < 0.01). The Annals of Thoracic Surgery 2014 97, 492-497DOI: (10.1016/j.athoracsur.2013.09.077) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Postoperative commissure-to-commissure (CC) diameter reduction rates throughout a cardiac cycle. The CC diameter is almost fixed throughout a cardiac cycle after each ring implantation. Data are mean ± SD. (N.S. = not significant.) The Annals of Thoracic Surgery 2014 97, 492-497DOI: (10.1016/j.athoracsur.2013.09.077) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Postoperative annular height commissure width ratio (AHCWR) in end systole. The Physio II and RSR rings restore the mitral annulus to a three-dimensional saddle shape equivalent to the normal control shape. However, the value in the MEMO ring is significantly smaller than those in the other two rings, so that it cannot actively affect the annulus. Data are mean ± SD (*p < 0.01). The Annals of Thoracic Surgery 2014 97, 492-497DOI: (10.1016/j.athoracsur.2013.09.077) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Postoperative annular height commissure width ratio (AHCWR) increase rates from end diastole (ED) to end systole (ES). The postoperative AHCWR increase rate from end diastole to end systole is significantly larger in the MEMO ring than in the other two rings. That can be translated to the folding annular dynamics, and the value for the MEMO ring is equivalent to the normal control value. Data are mean ± SD (*p < 0.01). The Annals of Thoracic Surgery 2014 97, 492-497DOI: (10.1016/j.athoracsur.2013.09.077) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions