Figure 2d from: Cirillo M (2020) Ring-first Mitral Valve Repair. Research Ideas and Outcomes 6: e62369. https://doi.org/10.3897/rio.6.e62369

Figure 2d The two most frequent types of mitral pathology: Barlow's disease (a and b) and fibroelastic deficiency (c and d). The pathological pictures are shown and the advantage of implanting the prosthetic ring before performing the repair of the valve leaflets is illustrated. - By implanting the ring as the first step, the valve area is reduced and assumes a more correct geometry, therefore the resection can be less extensive (triangular, dashed lines).