Key Points
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Annuloplasty rings may be inserted to support mitral or tricuspid valve repairs.
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The radiographic appearance of annuloplasty rings varies according to the design and includes partial ( C -shaped) and complete ( O -shaped and kidney-shaped) rings, and two-dimensional and three-dimensional round and kidney-shaped rings.
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Most annuloplasty rings can be identified on and localized by chest radiography. The lateral chest radiograph often assists with obviating the projection of a mitral annuloplasty ring onto the spine, particularly in large hearts that otherwise may diminish the depiction of annuloplasty rings on the frontal radiograph.
Annuloplasty rings may be inserted onto either the mitral or tricuspid valve annulus to correct annular dilation as a contributing cause of mitral or tricuspid insufficiency ( Graphic 11-1 and Table 11-1 ). Novel percutaneously inserted devices that crimp the coronary sinus, and thus the nearby mitral annulus, are increasingly inserted ( Fig. 11-1 ). Mitral annular rings may be inserted within the context of pure mitral valve surgery, usually, but not always, in conjunction with a mitral repair procedure. Alternatively, they may be placed as a secondary indication for ischemic or myxomatous mitral regurgitation in the context of primary indication of coronary bypass surgery ( Figs. 11-2 to 11-9 ). Conversely, tricuspid annular rings are almost always inserted in the context of a primary indication of mitral valve surgery (repair/replacement of commissurotomy) when there is a problematic degree of associated tricuspid insufficiency due to right heart dilation. Only in rare and highly selected patients is tricuspid valve repair/annuloplasty a primary and sole intervention.
| Shape | Radiopacity | |
|---|---|---|
| Mitral Rings | ||
| Complete Rings | ||
| Carpentier-Edwards Classic | Kidney-shaped | Radiopaque (titanium-containing) |
| Carpentier-Edwards Physio | Flatter on top, rounder on bottom | Radiopaque (Elgiloy) |
| Carpentier-McCarthy-Adams IMR ETlogix | Asymmetrically shaped to obviate the effect of asymmetric annular dilation | NA |
| Edwards GeoForm | Complex shape to obviate the effect of left ventricular dilation on the annulus | NA |
| Medtronic Duran flexible ring | Round | Radiopaque |
| St. Jude Medical Séguin | Round or kidney-shaped | NA |
| St. Jude Medical Tailor | Kidney-shapedCan be trimmed anteriorly to be open | NA |
| Sorin-CarboMedics Annulo Flex | Complete or partial ring — can be cut | Radiopaque (barium-containing) |
| Sorin Sovering | Includes round | Radiopaque (barium-containing) |
| Genesee Sculptor | NA | NA |
| Jostra fully flexible | NA | NA |
| Jostra La Pitié | NA | NA |
| Shelhigh BioRing | Polyester and pericardium | Nonradiopaque? |
| ATS Simulus FLX-O | NA | NA |
| Partial Rings | ||
| Cosgrove-Edwards | Widely open C shape | Radiopaque (barium-containing) |
| Medtronic Duran Flexible band | Widely open C shape, for posterior annular repair | NA |
| Medtronic Colvin-Galloway Future Band | Widely open C shape with wider ends | Radiopaque |
| St. Jude Medical Tailor | Kidney-shapedComplete ring but can be trimmed anteriorly to be open | NA |
| St. Jude Medical Tailor (band) | Kidney-shaped | NA |
| St. Jude Medical Rigid Saddle | Kidney-shaped | NA |
| Sorin-CarboMedics Annulo Flo | Kidney-shaped | Radiopaque (titanium-containing) |
| Sorin-CarboMedics Annulo Flex | Complete or partial ring (can be cut) | Radiopaque (barium-containing) |
| Sorin Sovering | Includes partially open C -shaped ring | Radiopaque (barium-containing) |
| Sorin Memo 3D | Radiopaque | |
| Koehler Mitral Repair System (MRS) | Radiopaque (barium-containing) | |
| ATS Simulus Annuloplasty FLX-O (band) | NA | |
| Tricuspid Rings | ||
| Complete Rings | ||
| Medtronic Duran Flexible | Round | Radiopaque |
| Jostra Fully Flexible | NA | NA |
| Jostra La Pitié | NA | NA |
| Partial Rings | ||
| Carpentier-Edwards Classic | Oval-shaped | Radiopaque (titanium-containing) |
| Edwards MC3 | NA | NA |
| Sorin Sovering | Include widely open C -shaped ring and more than half open C -shaped rings | Radiopaque (barium-containing) |
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