Rostagno Carlo, Droandi Ginevra, Rossi Alessandra, Bevilacqua Sergio, Romagnoli Stefano, Montesi Gian Franco, Stefàno Pier Luigi
Ital J Anat Embryol. 2014;119(1):20-8.
Barlow disease is a still challenging pathology for the surgeon. Aim of the present study is to report anatomic abnormalities of mitral valve in patients undergoing mitral valve repair.
Between January 1st, 2007, and December 31st, 2010, 85 consecutive patients (54 men and 31 women, mean age 59 +/- 14 years--range: 28-85 years) with the features of a Barlow mitral valve disease underwent mitral repair Forty seven percent of patients were in New York Heart Association functional class III or IV. Preoperative transesophageal echocardiography was compared with anatomical findings at the moment of surgery.
Transthoracic echocardiography diagnosis of Barlow disease according to the criteria described by Carpentier was confirmed at anatomical inspection. Annular calcifications were found in 28 patients while 7 patients presented single or multiple clefts. A flail posterior mitral leaflet was detected in 32 subjects, while a flail anterior leaflet in 8. Elongation of chordae tendineae was demonstrated in 45 patients and chordal rupture in 31. All patients showed at trans esophageal echocardiography the typical features of Barlow disease. Seventy-seven (90.6%) patients had severe mitral valve regurgitation, in the remaining 9.4% it was moderate to severe. Transesophageal echocardiography failed to identify clefts in 2/7 and chordal rupture in 4/31.
bileaflet prolapse > 2 mm, billowing valve with excess tissue and thickened leaflets > or = 3 mm, and severe annular dilatation, are characteristics of Barlow disease, however the identification of the associated and complex abnormalities of mitral valve is necessary to obtain optimal valve repair.
对于外科医生而言，巴洛病仍是一种具有挑战性的病症。本研究的目的是报告接受二尖瓣修复手术患者的二尖瓣解剖学异常情况。
在2007年1月1日至2010年12月31日期间，85例连续的具有巴洛二尖瓣疾病特征的患者（54例男性和31例女性，平均年龄59±14岁，范围：28 - 85岁）接受了二尖瓣修复手术。47%的患者处于纽约心脏协会心功能Ⅲ或Ⅳ级。将术前经食管超声心动图检查结果与手术时的解剖学发现进行比较。
经胸超声心动图根据Carpentier描述的标准对巴洛病的诊断在解剖检查时得到证实。28例患者发现有瓣环钙化，7例患者存在单个或多个瓣叶裂。32例患者检测到二尖瓣后叶脱垂，8例患者检测到前叶脱垂。45例患者显示腱索延长，31例患者存在腱索断裂。所有患者经食管超声心动图均显示出巴洛病的典型特征。77例（90.6%）患者有严重二尖瓣反流，其余9.4%为中重度反流。经食管超声心动图未能识别出7例中的2例瓣叶裂以及31例中的4例腱索断裂。
双叶脱垂>2mm、瓣膜膨出伴过多组织以及瓣叶增厚≥3mm，以及严重瓣环扩张，是巴洛病的特征，然而，识别二尖瓣相关的复杂异常对于实现最佳瓣膜修复是必要的。
