Does the clover technique fit the annular physiology?

Abstract

WehavereadthestudyofLapennaetal.withgreatinterest [1]. We think that these techniques are not compatible with the co-aptation physiology. Our concerns are as follows. If we apply the clover technique to a normal (without regurgitation) tricuspid valve, would this create an insufficiency? Yes, it would. This is because the free edges of the leaflets could not adapt to changes in filling and stroke volumes and ejection fractions after the clover technique. In the changing volume system, do not the leaflet edges change their locations at the annular plane? What kind of strategies did the authors use to prevent this? The tricuspid annulus shrinks from diastole to systole, thus decreasing its area and contributing to co-aptation. Flexible rings change the annular shape and decrease the annular area. (Can the flexible rings you used decrease their circumference?) These changes occur through bulging internally orexternally and inferiorly orsuperiorly.Wouldnot these changes disrupt the co-aptation mechanism? In the de-Vega annuloplasty technique, we could not be sure of co-aptation. This is because we leave the initiative to annular movement and regurgitating volume regarding what part of the annulus would shrink. In rupture of chordae, why did the authors not think to treat this situation without formation of a new chordae?