Posterior pericardial annuloplasty: a physicological correction?

Since the introduction of the annuloplasty ring, many attempts have beenmade to obtain a flexible ring that preserves the physiological motion ofthe mitral annulus. We experimented with a new technique using autologouspericardium to construct a more flexible ring. Twenty patients underwentmitral valve repair for degenerative disease and were treated by aposterior pericardial annuloplasty and the usual valvuloplasty procedures.A long strip of pericardium was prepared, marked with metal clips androlled up in a tubular fashion with the serosal surface on the outside. Thepericardial tube was apposed on the posterior annulus just beyond thecommissures. No patient required early or late reoperation. Doppleranalysis showed good valve function: 18 patients had no or mild, and 2 hadmoderate regurgitation. Transmitral flow indexes were nearly normal (MVA =3.7 +/- 0.4 cm2; flow velocity peak = 1.06 +/- 0.2 m/s). Fluoroscopicexamination was employed for assessing annular motion using the metal clipsas radiopaque markers. Planimetry of the hemiarea showed a mild narrowing(mean 8.5% +/- 6.4%) of annular size during ventricular systole. There wasa trend toward a systolic reduction of the anteroposterior diameter of theannulus. These findings demonstrate that the mitral orifice preserves itsflexible properties after this type of annuloplasty. Posterior pericardialannuloplasty seems to be a physiological correction of annular dilatationin patients with degenerative disease.