MO11. The Sole Use of Ring Can Repair Barlow's Bi-leaflet Prolapse

8 Minutes 

New York Hilton Midtown 

Objective: Barlow's disease is characterized by diffuse excess tissue, quite a large valve size, multiple segments affected with myxomatous pathological changes, and diffuse chordal elongation in addition to chordal rupture. Therefore, mitral valve repair for Barlow's disease is usually demanding. In a subpopulation of Barlow patients with bileaflet prolapse, central regurgitant jet without chordal rupture, we performed mitral repair using only a semi-rigid annuloplasty ring. Clinical outcomes were evaluated.
Methods: Of a total of 170 consecutive patients who underwent MVP, 13 patients who had anatomical features of Barlow's disease underwent MVP. The mean age was 60 years. All patients presented with large annulus size, myxomatous bileaflet prolapse, and multiple chordal elongations with(n=6) or without chordal ruptures (n=7) and were considered to have Barlow's disease. Patients were evaluated at discharge and after a mean follow-up of 26 ± 19 months by echocardiography.
Results: All patients received full ring, including CG future in 5 (32 mm:1, 34 mm: 2, 36 mm: 2), CE Physio Ⅱ in 8 (34 mm: 1, 36mm: 4, 38 mm: 3 ). Of these 13 patients, 4 were cured only by using a mitral annuloplasty semi-rigid ring. Additionally, the remaining 9 patients underwent leaflet plication and/or artificial chordal replacement. Concomitant procedures included TAP in 6, Maze in 4, LAAC in 6, PVR in 1. Hospital mortality was 0%. Postoperative echocardiography revealed no or trace MR in 9 patients and mild in 3 patients. The mean follow-up duration was 26 months. We encountered mild to moderate MR in 1 patient. No patient required reoperation for recurrent more than moderate MR. Among 7 patients who presented with large annulus size, myxomatous bileaflet prolapse, and multiple chordal elongations without chordal ruptures, early 3 cases were cured by a mitral annuloplasty and leaflet plication and/or artificial chordal replacement and the latest 4 cases were cured only by a mitral annuloplasty. At the latest follow-up, residual mitral regurgitation was trivial in 6 and mild in 1 case．
Conclusions: Severe mitral regurgitation due to Barlow's disease with multiple central jet and without chordal rupture can be effectively treated by mitral annuloplasty.

5-minute presentation; 3-minute discussion