Functional Prolapse in Barlow's Syndrome: Endoscopic Mitral Valve Repair

Objectives: Mitral valve repair is the gold standard for mitral valve regurgitation. A Barlow valve is considered difficult to repair due to complex pathology. A simple repair strategy is feasible in a subgroup of patients presenting with a functional prolapse due to a left ventricular wall motion abnormality and paradox movement of papillary muscles, together with a disjunction of the mitral valve annulus.

Methods: From 2015 to 9/2020, endoscopic repair was performed in 376 patients at our center. We identified 28 Barlow's syndrome patients (18 females, 10 males) with a functional prolapse. Totally endoscopic procedure was performed in our routine fashion using a 3D video system. The repair strategy consisted of implantation of a large annuloplasty ring together with height reduction of the posterior leaflet. The prolapsing anterior leaflet was not treated at all.

Result: Mean age was typically rather young (55 years). Repair was feasible in all patients, no conversion to sternotomy was necessary. Perioperative mortality and morbidity were 0%. The repair result was perfect with no or only trace of regurgitation at discharge. Follow-up after 24 months (mean) revealed stable repair results with 100% success rate.

Conclusion: Barlow's syndrome patients with a functional prolapse can be treated successfully with a simple repair strategy. The results of this technique are promising according to the literature and support our own excellent early and midterm outcomes in endoscopically treated patients.

Publication History

Article published online:
19 February 2021