Department of Cardiac Surgery, Heart Institute of Ho Chi Minh City-Alan Carpentier Foundation, 4 Duong Quang Trung, District 10, Ho Chi Minh City, Vietnam.
International Medical Center, University of Tsukuba Hospital, Tsukuba, Japan.
Gen Thorac Cardiovasc Surg. 2024 Dec;72(12):763-769. doi: 10.1007/s11748-024-02040-y. Epub 2024 Jun 4.
Mitral valve repair for Barlow's disease offers good outcomes but excessive and myxomatous valvular tissue is associated with systolic anterior motion. Although valvular disease might progress after repair and cause long-term systolic anterior motion, few reports focus on this aspect. Herein, we will review our 16-year experience with mitral valve repair for Barlow's disease and systolic anterior motion incidence.
We retrospectively reviewed surgical outcomes of 92 cases of mitral valve repair using a balanced leaflet/large ring strategy plus median sternotomy for Barlow's disease (median age 45.1 ± 12.7 years old [19-72], 37 females) from 2004 to 2019. Concomitant surgeries, except for tricuspid valve or anti-arrhythmic surgeries, were excluded.
The follow-up period was 5.8 ± 4.4 years with no deaths. Patients had mitral regurgitation of grade 3/4 (15 cases) or 4/4 (77 cases) due to anterior leaflet (3 cases), posterior leaflet (75 cases), or bileaflet (14 cases) prolapse, with chord elongation (39 cases), chord rupture (22 cases), or a combination of both (14 cases). All cases required ring annuloplasty (median size of 33.0 ± 5.4 mm) combined with leaflet resection (91 cases), chord intervention (12 cases), or indentation closure (2 cases). No case had short- or long-term SAM. The freedom-from-mitral-regurgitation (of greater than grade 2/4) rate was 94.1% over 5 years and 76.0% over 10 years without reoperation.
Our two-pronged strategy for mitral valve repair in Barlow's disease avoids systolic anterior motion over the long-term, with good outcomes.
二尖瓣修复术治疗巴洛氏病可获得良好的结果，但过多和黏液样的瓣叶组织与收缩期前向运动有关。尽管瓣叶疾病可能在修复后进展并导致长期收缩期前向运动，但很少有报道关注这一方面。在此，我们将回顾我们 16 年来采用二尖瓣瓣叶/大环修复策略联合正中开胸术治疗巴洛氏病伴收缩期前向运动的经验。
我们回顾性分析了 2004 年至 2019 年间采用二尖瓣瓣叶/大环修复策略联合正中开胸术治疗 92 例巴洛氏病（平均年龄 45.1±12.7 岁[19-72 岁]，女性 37 例）的手术结果。除外三尖瓣或抗心律失常手术等合并手术。
中位随访时间为 5.8±4.4 年，无死亡病例。患者因前瓣叶（3 例）、后瓣叶（75 例）或双瓣叶（14 例）脱垂、瓣叶腱索延长（39 例）、瓣叶腱索断裂（22 例）或两者均有（14 例）而出现 3/4 级（15 例）或 4/4 级（77 例）的二尖瓣反流。所有病例均行环行瓣环成形术（平均直径 33.0±5.4mm）联合瓣叶切除术（91 例）、腱索干预术（12 例）或切迹闭合术（2 例）。无病例出现短期或长期的收缩期前向运动。5 年无二尖瓣反流（大于 2/4 级）的生存率为 94.1%，10 年无二尖瓣反流（大于 2/4 级）的生存率为 76.0%，且无再次手术。
我们对巴洛氏病二尖瓣修复的双管齐下策略可长期避免收缩期前向运动，获得良好的效果。
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