Repair of bileaflet prolapse in Barlow syndrome: The 4‐chord technique

Abstract

Barlow syndrome is a form of degenerative mitral valve (MV) disease found in a subset of patients with bileaflet prolapse. The hallmark of Barlow's disease includes excessive and billowing leaflet tissue caused by myxomatous tissue proliferation, elongated chordae, and pronounced annular dilatation. Surgical repair of patients with Barlow's disease is challenging due to the extent of the leaflet and annular abnormalities. Several techniques have been described to repair Barlow's MV including currently popular “non‐resectional” approaches. Repair with neochordae has been associated with excellent results and includes the advantage of preserved leaflet mobility and a large surface of coaptation. We describe a simple approach to the use of neochordae to repair bileaflet prolapse in patients with Barlow syndrome and avoid systolic anterior motion.

Biomechanical characteristics of different methods of neo‐chordal fixation to the papillary muscles

“…7 It is generally recommended to attach the artificial neo-chordae to the fibrous portion of the head of the papillary muscle to minimize injury to the muscle tissue. There are multiple stitching techniques that have been described to anchor the ePTFE neo-chordae to the papillary muscles 8 such using a simple nonknotted stitch, [9][10][11] a figureof-eight stitch, [12][13][14] a mattress stitch reinforced with a single unknotted pledget 15,16 and a mattress stitch reinforced with two pledgets knotted over the papillary muscle. [17][18][19][20] In vitro studies have shown that both the knotted mattress stitch with two pledgets and the figure-of-eight stitch provided adequate tensile strength within the limits of normal physiological range.…”