Repair of bileaflet prolapse in Barlow syndrome

Mitral valve (MV) leaflet billowing, prolapse, and excessive tissue are hallmarks of Barlow syndrome. Successful MV repair can be a challenge in these oftentimes young and otherwise healthy patients. We herein present details on our stepwise approach to MV repair for Barlow syndrome including: (1) surgical approach; (2) MV exposure; (3) assessment of MV pathology; (4) repair of leaflet prolapse; (5) choice and sizing of annuloplasty ring; and (6) fine-tuning and troubleshooting. Our repair strategy involves extensive use of Gore-Tex neochordae using the so-called "loop technique." We have used this operative strategy via a right mini-thoracotomy in 436 patients with bileaflet prolapse and 144 patients with Barlow syndrome. Our successful MV repair rate is 95% in patients with Barlow syndrome and the ten-year freedom from reoperation rate is 96% for such patients. We can conclude that a stepwise approach to this MV pathology with extensive use of the loop technique can result in very acceptable outcomes, even in patients undergoing minimal invasive surgery.