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The Sliding Ruler Retrograde Measurements of the Mitral Valve Dimensions for a 3-D Optimal Geometry Annuloplasty Device
Aram K. Smolinsky.
Assuta Medical Center, Tel Aviv, Israel.

Objectives The conventional mitral valve repair measurements are based on standard sizers, one for each inter-trigone distance (ITD). "Excessive" posterior leaflet is trimmed to fit. A measurement logic meant to account separately for all the individual valve dimensions: height, width, coaptation height and coaptation point depth is introduced. It is based on the anatomic findings that the base of P2 is equal to the ITD, throughout the growth of the normal hearts, opposite to the common findings of dilated posterior ring in the hearts with mitral regurgitation. Methods The retrograde sliding ruler measurements; the end point of previous measurement is the zero point for the next. The point at the middle of the base of P2, known as the 6 O'clock point, is the reference starting point. The zero point of the device is its middle, and is coupled to the 6 O'clock point. This segment of the device should be preferably rigid. Next the two margins of the base of P2 are coupled to the device so as to be ITD apart. This becomes the new zero point for the next measurement, the AP diameter. The flexible lateral extensions of the device are adjusted and coupled to P1 and P3. Their measurement has to allow the extra length needed for the coaptation length and depth. The anterior completion to full ring is optional. Redundant device length is chopped off. In no case is the height of the posterior leaflet reduced. Results This measurement logic allows a singe size device size which still accommodate the particular patient leaflets geometry. There is no generalization: It is a single size custom measured and fit. There is no mitral valve area reduction and no space for SAM. Conclusion Every mitral valve has its own individual dimensions. With the retro- grade sliding ruler anatomically adjusted measurements, one employs the same basic device for all repairs, yet accomplishes the optimal annuloplasty size and geometry for each specific valve.

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