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FIGURE 63.4 Original transvalvular technique of internal valve repair. A. Diagrammatic appearance of sagging valve cusps as seen in the opened vein prerepair. B. Technique of shortening the leading edge of the valve cusp for 2-3 mm distance with interrupted 7-0 monofilament suture introduced at the level of the commissure passing from outside to inside the vein, through the cusp near its leading edge, then returned to the level of the commissure and passing from inside to outside of the vein. C. Introducing further similarly placed sutures, which will be done at both sides of the opened vein and in the center of the vein where both valves meet. D. Appearance of valve cusps after shortening the cusps to an appropriate length. This may require 4-10 such sutures.

FIGURE 63.5 Original technique of external valve repair. A. Interrupted sutures begin at the upper level of the commissure where the valve cusps originate. The suture passes into the vein from the outside to the inside to engage the valve cusps and is tied outside of the vein. B. A series of similarly placed sutures passing down the valve secure the progressively decussating margin of the valve insertions until the base of the valve is reached. C. Similarly placed sutures are then placed along the margins of the cusps on the opposite side of the vein.

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