Annuloplasty
At the last stage of MVr, a conventional water test is always performed
without annuloplasty ring and sutures. If the water test is not perfect,
we seek for remaining problems, but we never rely on the annuloplasty to
eradicate a residual leak.
We use annuloplasty rings in all patients (but alternatively, bands from
one trigone to the other could be employed) measuring the size according
to the unfolded anterior leaflet and always using the upper size in case
of a doubt. In our view, an annuloplasty is mandatory to reshape the
annulus and to decrease the tension on it. It should be stressed that
annuloplasty does not promote coaptation. Coaptation should be achieved
before any annuloplasty.
Finally, there are more and more concerns about the use of rings that
are too small, creating dynamic mitral stenosis. In Barlow, rings and
bands should be at least the same size as the anterior leaflet and
probably slightly bigger.