A Method to Avoid Annular Downsizing During Knot Tying

Pericardial annuloplasty has been used as an alternative to prosthetic annuloplasty. One drawback of pericardial annuloplasty is the risk of cinching of tissues during knot tying, possibly leading to uncontrolled downsizing and to complications such as mitral stenosis and systolic anterior motion of the anterior leaflet. A simple modification of the sequence of knot tying is described to avoid this complication.