Nonresectional Repair of the Barlow Mitral Valve: Importance of Dynamic Annular Evaluation

Background: The most extensive form of myxomatous degeneration of the mitral valve causing severe mitral regurgitation is "Barlow disease." Surgical repair of this condition has been considered difficult because of the extent and magnitude of annular, leaflet, and chordal abnormalities and has usually involved partial resection of one or both mitral leaflets. Methods: A surgical approach has been developed which does not involve leaflet resection. Instead, by means of precise dynamic annular sizing, a predetermined zone of leaflet apposition is achieved. The leaflets are positioned so that their large area is contained within the left ventricle. Normal annular, leaflet, and papillary muscle dynamic function is restored. Results: This procedure was performed in 61 patients. The repair rate was 100%. The mean age was 57.6 ± 12.7 years. They were 67.2% male. The preoperative anteroposterior annular dimension was 52.1 ± 4.3 mm. The full, flexible complete ring size was 33.4 ± 1.9 mm. There was no perioperative mortality. There was no systolic anterior leaflet motion. All patients were discharged with no or mild mitral regurgitation. At a follow-up interval of 1.2 ± 2.1 years one patient had developed recurrent mitral regurgitation, secondary to marked remodeling to normal left ventricular function. Conclusions: Initial experience with a nonresectional approach for Barlow disease has produced good early results.