Figure 2

Operative procedures. A. After the prolapsed leaflet segments and chordae were excised, the anterior commissural defect was made. B. The defect was closed with an elliptical pericardial patch of 2.0 × 1.0 cm size. An adjustable DeVega-type annuloplasty using two continuous 5–0 Polypropylene sutures was performed to select an appropriate-size ring for complete leaflet coaptation. C. A 26-mm Edward MC³ ring was placed using two interrupted, pledgeted 2–0 Dacron sutures and two continuous 3–0 polypropylene sutures. The anterior horn of the rigid ring (black arrow) was sutured to the medial end of the patch.