Morten O. Jensen, PhD, Henrik Jensen, MD, PhD, Robert A

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Saddle-shaped mitral valve annuloplasty rings improve leaflet coaptation geometry Morten O. Jensen, PhD, Henrik Jensen, MD, PhD, Robert A. Levine, MD, Ajit P. Yoganathan, PhD, Niels Trolle Andersen, PhD, Hans Nygaard, DMSc, J. Michael Hasenkam, MD, DMSc, Sten L. Nielsen, MD, PhD, DMSc The Journal of Thoracic and Cardiovascular Surgery Volume 142, Issue 3, Pages 697-703 (September 2011) DOI: 10.1016/j.jtcvs.2011.01.022 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Ultrasound images from the biplane echocardiographic system with indication of mitral leaflet geometry analysis landmarks. A, Example of mid-systole before ring implantation. α, Anterior leaflet systolic coaptation angle (between anterior leaflet and mitral annulus); β, coaptation angle of posterior leaflet; h, coaptation tenting height. B, Mid-systole with a flat ring implanted. The anterior leaflet is aligned flat with the annulus. C, Example of mid-diastole leaflet configuration before ring implantation; α′, Anterior leaflet diastolic opening angle. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 697-703DOI: (10.1016/j.jtcvs.2011.01.022) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Schematic indication of systolic mitral leaflet geometry analysis landmarks. A, Mitral valve coaptation tenting area. B, Anterior leaflet systolic curvature angle (θ). C, Radius of anterior leaflet systolic circumscribed circle (r). The Journal of Thoracic and Cardiovascular Surgery 2011 142, 697-703DOI: (10.1016/j.jtcvs.2011.01.022) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Potential mechanism for altered mitral valve leaflet configuration with (A) flat and (B) saddle-shaped annuloplasty rings from a lateral view (top figures) and an anterior view (bottom figures). The flat annuloplasty ring may hoist the papillary muscles laterally through the commissural chords (illustrated by dotted lines in the top figures). The saddle-shaped ring maintained the medial alignment of the papillary muscles to facilitate proper leaflet coaptation. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 697-703DOI: (10.1016/j.jtcvs.2011.01.022) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions