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Mitral Valve Repair for Barlow's Disease with Mitral Annular and Subvalvular Calcification: A Case Report

Kosuke Nakamae1, Takashi Oshitomi1, Kentaro Takaji1

  • 1Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan.

Journal of Chest Surgery
|March 8, 2022
PubMed

Insights

Mitral valve repair for Barlow's disease with extensive calcification is complex. This case demonstrates a successful individualized surgical strategy involving resection and artificial chordae implantation.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Valve Disease
  • Mitral Valve Repair

Background:

  • Barlow's disease, characterized by myxomatous degeneration of the mitral valve, can present with severe mitral annular calcification (MAC).
  • MAC encasing the subvalvular apparatus (leaflets and chordae) poses significant challenges for mitral valve repair.
  • Surgical repair in such complex cases requires tailored strategies to address both Barlow's disease and extensive calcification.

Observation:

  • A 60-year-old woman presented with mitral valve regurgitation due to Barlow's disease and extensive MAC.
  • The calcification involved the mitral valve leaflets and subvalvular apparatus, complicating standard repair techniques.

Findings:

  • A successful mitral valve repair was achieved by resecting specific calcified areas (P2 rough zone, excess leaflet regions) while preserving other calcifications (P3).
  • The procedure involved implanting artificial chordae and an annuloplasty ring to restore valve function.
  • This individualized approach effectively controlled mitral valve regurgitation.

Implications:

  • This case highlights the feasibility of complex mitral valve repair in rare instances of Barlow's disease with extensive MAC.
  • An individualized and compounded surgical strategy is crucial for successful outcomes in these challenging cases.
  • The findings suggest that meticulous surgical planning and technique can overcome significant anatomical obstacles in mitral valve surgery.

Keywords:
Barlow’s diseaseCase reportDecalcificationHeart valve diseasesMitral valve repair

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