Current concepts in Barlow’s valve reconstruction
Degenerative mitral valve diseases constitute a spectrum of lesions, varying from simple chordal rupture involving prolapse of an isolated segment in an otherwise normal valve to multisegmental prolapse involving one or both leaflets in a valve with significant excess tissue and a large annular size. Barlow syndrome is the most advanced and complex entity in this spectrum and is distinguished by the characteristic presence of diffuse and complex redundancy of the valve due to myxomatous degeneration (◘ Fig. 12.1a), producing prolapse of multiple segments in one or both leaflets (◘ Fig. 12.1b). Severe annular dilatation with giant valve size is evident (ring size ≥36 mm). In addition, varying degrees of annular calcification is often observed, as well as subvalvular fibrosis and calcification of the papillary muscles, in particular the anterior papillary muscle (◘ Fig. 12.1c). Therefore, surgical repair of the Barlow valve may present specific challenges. In this chapter, we describe our systematic approach to Barlow valve repair; we have found it to possible to repair essentially all Barlow valves by consistent application of the outlined principals.
KeywordsMitral Valve Repair Anterior Leaflet Posterior Leaflet Annuloplasty Ring Systolic Anterior Motion
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