Respect or resect in Barlow disease

Mitral regurgitation in Barlow disease may still be challenging to be repaired. Most often it involves the posterior leaflet. Many techniques and concepts are currently available; the main goal being to restore a good surface of coaptation. Basic principles such as thorough analysis is still required whatever the approach to assess excess tissue height, width, and prolapse. Nowadays it seems that two different ways of treating mitral prolapse coexist: the nonresection one and the resection one. Both will be discussed and analyzed. Similarly, the use of artificial chordae seems to have a preponderant role to support the free edge and correct a prolapse. Native secondary chord transfer are easy and reliable but seem abandoned by many. Anterior leaflet prolapse is also dealt with and fewer options are available to address this leaflet. Then commissural prolapse is mentioned. It is an important area of the valve which should deserve better treatment than commissuroplasty. Finally, a special entity will be described; mitro annular disjunction. The approach is not or no longer an issue as only good long-term results are important in an era where percutaneous therapy is the only noninvasive technique.