Figure 1:
(A) The anterior edge between the artificial chord’s anchor and the native first-order chord’s attachment is stretched by the assistant using a nerve hook. The new chord is pulled down with forceps parallel with the stretched native chord toward the appropriate papillary muscle; a metal clip is placed across the two arms at the level of the papillary
muscle’s tip.
(B) Non-sliding knot is tied against the metal clip, which is subsequently removed.
(C) Illustration represents the couple of sutures are anchored on the edge of anterior leaflet at five and seven o’clock positions, the posterior leaflet has been repaired by limited triangular resection. Before the ring’s implantation, the two sutures are passed through the posterior annulus at five and seven o’clock locations, and are left untied.
(D) Cross-profile Illustration represents an annuloplasty Physio ring in its final position. The untied Gore -Tex suture is outside the ring and the two needles are passed through the posterior prosthetic sheath. Cross-profile shows the new stitches are tightly tied on the posterior prosthetic sheath and the paradoxical “function” of the new chords: thus they are slack while the other chords of the subvalvular apparatus are firmly stretched during the saline injection test.