1. Novel suture device for beating-heart mitral leaflet approximation
Ottavio Alfieri, MD, John A Elefteriades, MD, Robert J Chapolini, MD, Robert Steckel, DVM, William J Allen, PE, Scott W Reed, BS, Stefan Schreck, PhD 
The Annals of Thoracic Surgery 
Volume 74, Issue 5, Pages (November 2002)
DOI: /S (02)

2. Fig 1
The edge-to-edge technique. Double-orifice repair on the left and paracommisural repair on the right.
The Annals of Thoracic Surgery  , DOI: ( /S (02) )

3. Fig 2
Overview of the surgical approach utilizing the suture device as it may be envisioned for use in a clinical procedure.
The Annals of Thoracic Surgery  , DOI: ( /S (02) )

4. Fig 3
The experimental device. (A) The suture device on the top, the knot pusher on the bottom, and the monofilament sutures with straight needles in the middle. The device passes into the cardiac chambers through a port access cannula in the left atrium (pictured in Fig 2). (B) Close-up view of the distal end of the suture device showing the two suction parts and the four needles partially deployed. (C) Schematic depiction of the method of firing of the stitches through the mitral valve (MV) leaflets. (LA = left atrium; LV = left ventricle.)
The Annals of Thoracic Surgery  , DOI: ( /S (02) )

5. Fig 4
Edge-to-edge approximation of the mitral valve in sheep. (A) Echocardiographic positioning images. (Left) Short-axis view. Note device going through circular image of mitral valve (MV) into left ventricle (LV) (into the plane of the figure). (Right) Long-axis view of same. (B) Echocardiographic image of the mitral valve approximated at the A2-P2 portions of the leaflets. (C) Mitral valve in situ taken immediately after completion of the edge-to-edge procedure. (LA= left atrium.)
The Annals of Thoracic Surgery  , DOI: ( /S (02) )

6. Fig 4
Edge-to-edge approximation of the mitral valve in sheep. (A) Echocardiographic positioning images. (Left) Short-axis view. Note device going through circular image of mitral valve (MV) into left ventricle (LV) (into the plane of the figure). (Right) Long-axis view of same. (B) Echocardiographic image of the mitral valve approximated at the A2-P2 portions of the leaflets. (C) Mitral valve in situ taken immediately after completion of the edge-to-edge procedure. (LA= left atrium.)
The Annals of Thoracic Surgery  , DOI: ( /S (02) )