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Updated: Jul 4, 2026

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels

Published on: May 26, 2023

What forces act on a flat rigid mitral annuloplasty ring?

Morten Ø Jensen¹, Henrik Jensen, Sten L Nielsen

¹Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus N, Denmark. morten.jensen@ki.au.dk

The Journal of Heart Valve Disease

|July 3, 2008

Summary

Flat mitral annuloplasty rings experience significant forces at the anterior and commissural areas. This suggests the mitral annulus attempts to reshape rigid rings, potentially impacting repair durability.

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Last Updated: Jul 4, 2026

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels

Published on: May 26, 2023

Area of Science:

Cardiovascular Surgery
Biomedical Engineering
Medical Devices

Background:

Mitral valve repair durability depends on annuloplasty ring performance.
Stress distribution within annuloplasty rings influences repair success.
Flat, rigid rings may lead to non-physiological myocardial loading due to altered annular geometry.

Purpose of the Study:

To investigate the three-dimensional (3-D) force distribution within mitral annuloplasty rings.
To test the hypothesis that annular geometry changes cause adverse strain in stiff, flat annuloplasty rings.

Main Methods:

Acute porcine study with eight animals.
Sonomicrometry used to assess mitral annulus 3-D dynamic geometry before ring implantation.
Strain gauges on rigid, flat annuloplasty rings measured dynamic forces perpendicular to the annulus.

Main Results:

Mitral annulus was fixed in a flat, diastolic configuration post-implantation (p <0.01).
Significant forces accumulated at the anterior (0.7 +/- 0.4 N) and commissural (1.4 +/- 1.0 N) segments.
These forces acted in opposite directions and were statistically significant (p <0.01; n=8).

Conclusions:

Highest strains observed in anterior and commissural areas of flat mitral annuloplasty rings.
Mitral annulus structures exert systolic torque on flat rings, attempting to create a saddle shape.
Findings support the hypothesis of non-physiological loading from stiff, flat annuloplasty rings.