Abstract
We extensively studied the relationship between the posterior mitral valve annulus and the surrounding coronary arteries, in a series of 85 explanted human hearts [3]. Right dominance was observed in 81.17% of the cases, balanced dominance in 16.47% and left dominance in 2.35%. Right dominant hearts showed that the shortest distance between the annulus and the coronary arteries occurred at the level of the anterior commissure, where the circumflex artery was distant to the annulus 3.99 1.86 mm (varying from 1.01 to 11.80 mm) while the longest distance was at the posterior commissure, measuring 7.78 2.61 mm. After this study, we altered the operative technique by placing the annular sutures slightly away from the annulus inwards the leaflets, particularly at the region nearby the anterior commissure. Therefore, a strategy of relocating the annular sutures in this setting proved to be feasible and effective. We commend again both authors for their fine contribution and reinforce that our procedure needs to be kept in mind should the need arise.
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