Technical aspects of mitral valve repair in Barlow's valve with prolapse of both leaflets: triangular resection for excess tissue, sophisticated chordal replacement, and their combination (the restoration technique).

Abstract

Histological degeneration in Barlow's valve mainly starts in the rough zone, frequently expands toward the chordae, and advances to the clear zone, resulting in a saccular aneurysm-like morphology in the prolapsed region. On this basis, we have repaired the prolapsed segment by triangular resection, chordal replacement and the combination (the restoration technique). The aim of this study was to report our initial findings and evaluate the efficacy of our technique. Twelve patients diagnosed with Barlow's valve with prolapse of both leaflets (5 women; mean age, 49years) underwent the restoration technique between January 2008 and March 2013. We retrospectively reviewed short-term clinical outcomes. The mean duration of the clinical follow-up was 2.5±1.7years. The restoration technique was successfully performed in all patients. Predominant repair techniques were isolated triangular resection (anterior 8, posterior 9), a combination of triangular resection with chordal replacement (anterior 1, posterior 1), and isolated chordal replacement (anterior 3, posterior 1). All patients underwent complete mitral annuloplasty, and the mean ring size was 31±2mm. In-hospital mortality was not noted. Late transthoracic echocardiography showed no or trace mitral regurgitation without significant systolic anterior motion in all patients. The New York Heart Association functional class was significantly improved from 1.3±0.5 before surgery to 1.0±0.0 after it (p<0.01). There were no late thromboembolic or bleeding events. Initial experience with the restoration technique has provided excellent results without significant systolic anterior motion. Our technique may contribute to improve late results in Barlow's valve.