1. A new technique for debridement in rheumatic valvular disease: the rasping procedure 
Nobuo Kitamura, MD, Shinichi Uemura, MD, Ryuji Kunitomo, MD, Junichi Utoh, MD, Sakashi Noji, MD 
The Annals of Thoracic Surgery 
Volume 69, Issue 1, Pages (January 2000)
DOI: /S (99)

2. Fig 1
Technique of A-rasping. (A) First, the prominent, thickened part of the edge of the cusps is removed by the blade. (B) After commissurotomy of each commissure, the rasping procedure is performed on the shaded area of the edge of the cusps, and on the surface of the cusp itself.
The Annals of Thoracic Surgery  , DOI: ( /S (99) )

3. Fig 2
Electric rasper. This rasper makes 20,000 revolutions per minute. The tip is interchangeable; tips of many shapes and sizes are available.
The Annals of Thoracic Surgery  , DOI: ( /S (99) )

4. Fig 3
Fiberscopic view of the aortic valve of a patient in the A-rasping group. (A) Preoperative rheumatic aortic valve, which exhibits stenoinsufficiency. (B) Fiberscopic view of the aortic valve: (right) aortic valve before the rasping procedure; (left) fiberscopic view after the rasping procedure shows perfect coaptation of the cusps, leaving no triangular central defect, at an aortic root pressure of 50 mm Hg.
The Annals of Thoracic Surgery  , DOI: ( /S (99) )

5. Fig 4
Results of the A-rasping procedure (n = 24). (AVR = aortic valve replacement; OP = operation; M = month; Grade = Sellers grade.)
The Annals of Thoracic Surgery  , DOI: ( /S (99) )