Annuloplasty Rings

Key Points

  • Annuloplasty rings may be inserted to support mitral or tricuspid valve repairs.

  • 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.

  • 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.

Graphic 11-1

Posteroanterior projection: Tricuspid and mitral annuloplasty rings.

TABLE 11-1

Annuloplasty Rings

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?
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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Apr 10, 2019 | Posted by in CARDIOVASCULAR IMAGING | Comments Off on Annuloplasty Rings
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