title: 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: OBJECTIVE
  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.
authors.affiliation: Department of Cardiac Surgery, European Hospital, Rome, Italy depauli@tin.it.
authors.forename: Ruggero
authors.initials: R
authors.lastname: De Paulis
authors.affiliation: Department of Cardiac Surgery, European Hospital, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Maselli
authors.affiliation: Department of Cardiac Surgery, European Hospital, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Salica
authors.affiliation: Department of Cardiac Surgery, European Hospital, Rome, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Leonetti
authors.affiliation: Department of Cardiac Surgery, European Hospital, Rome, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Guerrieri Wolf
authors.affiliation: Department of Cardiac Surgery, European Hospital, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Weltert
authors.affiliation: Department of Cardiac Surgery, European Hospital, Rome, Italy.
authors.forename: Saverio
authors.initials: S
authors.lastname: Nardella
authors.affiliation: Department of Cardiac Surgery, European Hospital, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bellisario
mesh_terms: D025401:Echocardiography, Stress / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008945:Mitral Valve Prolapse / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Annuloplasty; Barlow's disease; Mitral valve; Regurgitation