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Repair of mitral valve billowing and prolapse (Barlow): the surgical technique

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Abstract

Mitral valve repair in patients with mitral valve billowing and prolapse (Barlow) can be a demanding surgical procedure. A mitral valve repair method, which incorporates the complete resection of the middle scallop of the posterior leaflet, a sliding and folding plasty with the remaining lateral scallops combined with a triangular resection of the anterior leaflet and a ring-annuloplasty was developed, which maximizes predictable anatomic and physiologic efficacy of this repair and minimizes unpredictable results. A total of 37 consecutive patients underwent mitral repair with this method from 1996 to 1998, with consistently excellent results. Short-term follow-up information collected after 22.7 ± 8.6 months showed one late death and 93.0% of all surviving patients in New York Heart Association functional class I or II. There were no late reoperations and no thromboembolic, bleeding, or other complications. No patient had recurrent mitral regurgitation.

Section snippets

Technique

Surgery was performed in ischemic cardiac arrest under cardiopulmonary bypass with moderate systemic hypothermia. The interatrial groove was incised and the right atrium dissected. With the left atrial roof exposed, the left atrial incision was carried out close to the mitral valve. A self-retaining retractor was used to expose the mitral valve. Accurate valve analysis using the two conceptual approaches, ie, functional and segmental, as advocated by Carpentier, was mandatory [6].

To reduce the

Comment

Mitral valve billowing and prolapse (Barlow) still remains a somewhat mysterious disease [4]. Probably because of the imprecise terminology, the frequency of progressive mitral valve regurgitation requiring subsequent surgery in patients with mitral billowing and prolapse remains hidden. On reviewing the literature it is evident that some confusion exists on mitral valve prolapse, as there is no uniform terminology and definition [9]. However, Barlow recommended accepting the concept of

Acknowledgements

The surgical procedures and collection of data for this manuscript have been performed at the Herz-Gefaess-Klinik GmbH Bad Neustadt, Germany, where the author was previously associated.

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