Mitral repair with the sole use of a semi-rigid band in a sub-population of patients with Barlow's disease: A 4-year follow-up with stress echocardiography

Abstract

OBJECTIVES: Surgical treatment of Barlow's disease is usually demanding. In a sub-population of Barlow patients with bileaflets prolapse and central regurgitant jet, we performed mitral repair using only a semi-rigid annuloplasty band. Stress echocardiography follow-up was evaluated. METHODS: Of a total of 350 consecutive patients with mitral prolapse, 69 had anatomical features of Barlow's disease. Of these, 40 with multiple large central jets without chordal rupture were repaired only using an annuloplasty band, and these constituted the study group. An echocardiographic study of the acute change in valvular and ventricular morphology before and after surgery was carried out. Patients were evaluated at discharge and after a mean follow-up of 4.7 ± 3.2 years by stress echocardiography. RESULTS: No death or reoperation occurred. Acute echocardiographic study revealed that mitral annuloplasty led to a significant migration of the leaflets towards the apex of the left ventricle. Coaptation length increased dramatically from 2.7 ± 0.8 to 11.3 ± 2.7 mm and a reduction in annular diameters and leaflet length was observed. The left ventricle was elongated (72.8 ± 6.9 vs 63.2 ± 8.1 mm) and the distance from the papillary muscle tip to the mitral annulus increased (anterior 30 ± 3.9 vs 20.3 ± 4.8 mm, posterior 29.7 ± 4.3 vs 20.8 ± 5.6 mm). At discharge, residual mitral regurgitation was mild in 1 case and trivial in 3. The results were confirmed at stress echocardiography follow-up with normal valve function at peak exercise. CONCLUSIONS: In patients with severe mitral regurgitation due to Barlow's disease with multiple central jet and without chordal rupture, mitral annuloplasty is effective in restoring mitral valve function owing to profound changes in mitral valve and left ventricle geometry. At follow-up, stress echocardiography confirms the results and the stability of the repair.