[Toward a paradigm for universal procedures of valve repair].

We developed novel methods to simplify valve repair techniques.Adequate exposure is crucial for mitral valve surgery. The right side of the pericardium is sutured to the chest wall, and both cava are mobilized and hitched up to the left. Then a longitudinal incision of the right side of the left atrium allows excellent exposure of the mitral valve.We have developed a new device for replace neochordae. This double-armed, double-hooked device is inserted through the loop formed by the neochordae, which is anchored on the papillary muscle and pass through the prolapsing segment. The device pulls up both leaflets and maintains the neochordae at the same length as that of the opposing normal chordae during tying slippery neochordae.A simple method to repair large prolapsing posterior leaflet was developed. The middle of the prolapsed portion is cut, and both sides are laid each other. The water test is made to confirm accurate closure,and 2 layers are sutured.A novel method for adjustable tricuspid annuloplasty was developed. A flexible annuroplasty band,through which an expanded polytetrafluoroethylene (ePTFE) thread was passed, was secured to the tricuspid annulus. The thread was snared from outside of the ejecting heart under observation by echocardiogram.