ABSTRACT. Mitral valvuloplasty (MVP) is used in dogs with refractory mitral regurgitation (MR); however, it is difficult to tie the artificial chord, i.e., the expanded polytetrafluoroethylene suture, at the planned height of the mitral valve, because of the slippery nature of the knot. The loop technique has resolved these difficulties in humans. Premanufactured loops (length, 8.0-15.0 Surgical treatments for dogs with mitral regurgitation (MR) have recently been reported [2,7,9,10,16,21]. Surgical options include mitral valvuloplasty (MVP), in which the patient's valve is preserved, and mitral valve replacement, in which an artificial valve is used. However, artificial valves are extremely expensive, and immense efforts are required to avoid thrombosis with anticoagulant administration [16]. Therefore, MVP is the most appropriate surgical treatment for dogs with MR.Expanded polytetrafluoroethylene (ePTFE) is used as an artificial chord for chordal reconstruction because of its strong, biocompatible, and flexible nature; however, due to its slippery nature, tying a knot becomes difficult [5,12,15]. Therefore, Mohr developed the loop technique in which 4-5 loops are fixed on a pledget using a single suture thread and double needles during surgery [22]. This technique does not have the above-mentioned drawbacks of the ePTFE sutures, and is used for minimally invasive surgery. This technique can be easily performed even in a narrow surgical area, as it requires only double-armed sutures and simple interrupted sutures [19,22]. The surgical area in dogs is very narrow, even in cases with cardiomegaly due to MR, because almost all the subjects are small-to medium-breed dogs [1,8]. Thus, use of the loop technique may be effective in dogs with MR.In the current modified loop technique, the loops were fashioned using CV-6 ePTFE sutures (Gore-Tex CV-6 ePTFE suture; Japan Gore-Tex Co., Ltd., Tokyo, Japan) and sterilized by ethylene oxide gas prior to surgery. Each loop was tied using 1 surgical knot and 5 square knots on the apparatus that was fixed at a length of 8.0-15.0 mm at 1.0-mm increments (Fig. 1).Open-heart surgery was performed by cardiopulmonary bypass using an extracorporeal circulation system (MERA Heart Lung Machine, HAS type; Senko Medical Instrument Manufacturing Co., Ltd., Tokyo, Japan) under moderate hypothermia (28°C) using common procedures [7,10,21]. After a left atriotomy was performed, the length of the strut chordae adjacent to the elongated chordae was measured using the scale (Fig. 2A); the value obtained was multiplied *CorrespondenCe to: Aoki, T., Department of Surgery, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa 252-5201, Japan. e-mail: t-aoki@azabu-u.ac.jp ©2013 The Japanese Society of Veterinary Science