Methods for repair of abnormal mitral valves

Abstract

Methods of remodeling an abnormal mitral valve with an annuloplasty ring having a reduced anterior-to-posterior dimension to restore coaptation between the mitral leaflets in mitral valve insufficiency (IMVI). The ring has a generally oval shaped body with a major axis perpendicular to a minor axis. An anterior section lies between anteriolateral and posteriomedial trigones, while a posterior section defines the remaining ring body and is divided into P 1 , P 2 , and P 3 segments. The anterior-to-posterior dimension of the ring body is reduced from conventional rings; such as by providing, in atrial plan view, a pulled-in P 3 segment. The ring body may have a downwardly deflected portion in the posterior section. The downwardly deflected portion may have an apex which is the lowest elevation of the ring body and may be offset with respect to the center of the downwardly deflected portion toward the P 3 segment.

What is claimed is: 
     
         1 . A method of remodelling an abnormal mitral valve annulus having a clinically measured native annulus “size” given in even mm increments corresponding to a transverse dimension across its orifice along a transverse axis, the annulus further having an anterior-posterior dimension along an anterior-posterior axis across its orifice perpendicular to the transverse axis, the abnormality of the mitral valve annulus exhibiting primarily in dilatation of a posterior aspect of the mitral annulus and reduced valve leaflet coaptation, the method comprising:
 implanting a continuous, closed generally rigid body around the annulus, wherein the rigid body forms a peripheral shape about an opening, the opening having a major axis dimension along a major axis perpendicular to a minor axis dimension along a minor axis, and wherein the ratio of the minor axis dimension to the major axis dimension is smaller than a ratio of the anterior-posterior dimension to the transverse dimension of the annulus, so as to constrict the annulus more along the anterior-posterior axis than along the transverse axis so as to constrict the dilated posterior aspect of the annulus and restore coaptation between the valve leaflets. 
 
     
     
         2 . The method of  claim 1 , wherein the ring body is “downsized” by reducing the minor axis dimension by between about 2-4 mm relative to the corresponding anterior-posterior dimension of the annulus. 
     
     
         3 . The method of  claim 1 , wherein the major axis dimension is smaller than the measured transverse dimension of the annulus. 
     
     
         4 . The method of  claim 1 , wherein the ratio of the minor axis dimension of the opening to the major axis dimension of the opening is less than 3:4. 
     
     
         5 . The method of  claim 4 , wherein the ratio of the minor axis dimension of the opening to the major axis dimension of the opening is less than or equal to 2.5:4. 
     
     
         6 . The method of  claim 1 , wherein the ring body comprises a metal. 
     
     
         7 . The method of  claim 1 , wherein the ring body has an anterior segment opposite a posterior segment which is divided into P 1 , P 2 , and P 3  segments, with the minor axis bisecting the P 2  segment, and wherein the posterior segment is asymmetric with the P 3  segment being located closer to the anterior segment than is the P 1  segment. 
     
     
         8 . The method of  claim 7 , wherein the posterior segment has a downward bow. 
     
     
         9 . The method of  claim 7 , wherein the rigid body is covered with a sewing cuff that has an enlarged portion around the periphery of the ring body in the P 3  segment that can accommodate two radially adjacent rows of suture lines, the method including sewing the annuloplasty ring to the annulus using the sewing cuff and securing the annuloplasty ring with two rows of suture lines at the enlarged portion of the sewing cuff. 
     
     
         10 . A method of remodelling an abnormal mitral valve annulus having a clinically measured native annulus “size” given in even mm increments corresponding to a transverse dimension across its orifice along a transverse axis, the annulus further having an anterior-posterior dimension along an anterior-posterior axis across its orifice perpendicular to the transverse axis, the abnormality of the mitral valve annulus exhibiting primarily in asymmetric dilatation of a posterior aspect of the mitral annulus and reduced valve leaflet coaptation, the method comprising:
 implanting a continuous, closed generally rigid body around the annulus, wherein the rigid body forms a peripheral shape about an opening, the opening defined by the ring body having a major axis perpendicular to a minor axis, and wherein the body is “downsized” with the peripheral shape smaller than the measured annulus so as to constrict the annulus when implanted, and wherein the ring body is reduced in size along the minor axis relative to the corresponding anterior-posterior dimension of the annulus a greater amount than the ring body is reduced in size along the major axis relative to the transverse dimension of the annulus, so as to constrict the dilated posterior aspect of the annulus and restore coaptation between the valve leaflets. 
 
     
     
         11 . The method of  claim 10 , wherein the ring body is “downsized” by reducing the minor axis dimension by between about 2-4 mm relative to the corresponding anterior-posterior dimension of the annulus. 
     
     
         12 . The method of  claim 10 , wherein the ring body is “downsized” by reducing the major axis dimension by between about 1.0-1.5 mm relative to the corresponding transverse dimension of the annulus. 
     
     
         13 . The method of  claim 10 , wherein the ratio of the minor axis dimension to the major axis dimension is less than 3:4. 
     
     
         14 . The method of  claim 13 , wherein the ratio of the minor axis dimension to the major axis dimension is less than or equal to 2.5:4. 
     
     
         15 . The method of  claim 10 , wherein the ring body comprises a metal. 
     
     
         16 . The method of  claim 15 , wherein the metal is titanium. 
     
     
         17 . The method of  claim 10 , wherein the ring body has an anterior segment opposite a posterior segment which is divided into P 1 , P 2 , and P 3  segments, with the minor axis bisecting the P 2  segment, and wherein the posterior segment is asymmetric with the P 3  segment being located closer to the anterior segment than is the P 1  segment. 
     
     
         18 . The method of  claim 17 , wherein the posterior segment has a downward bow. 
     
     
         19 . The method of  claim 17 , wherein the rigid body is covered with a sewing cuff that has an enlarged portion around the periphery of the ring body in the P 3  segment that can accommodate two radially adjacent rows of suture lines, the method including sewing the annuloplasty ring to the annulus using the sewing cuff and securing the annuloplasty ring with two rows of suture lines at the enlarged portion of the sewing cuff. 
     
     
         20 . The method of  claim 19 , further including markings provided on the sewing cuff to indicate placement of the two radially adjacent rows of suture lines.