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Ann Thorac Surg 2004;78:1880
© 2004 The Society of Thoracic Surgeons

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Correspondence

Reply

Cardiac Clinic, Department of Cardiovascular Surgery, Hospital Lainz, Viznra, Josef-Striningre-Platz 2, Gabelsburg, Austria 3550

rfasol{at}imc-hospital.com

To the Editor:

My colleague and I read with great interest and appreciation the comments of Tanaka and Takeda on our article [1], which described a novel and simplified surgical technique for repair of mitral valve billowing and prolapse (Barlow's disease). The authors agree with our concept and confirm that triangular resection of the anterior leaflet seems a "safe and simple" technique. They [2] also reported good results in a "typical" case.

However, some time ago, triangular resection of the anterior leaflet fell out of favor [3]. Furthermore, some authors [4] suggested that if resection of the anterior leaflet is performed, the extent of the resection should be limited to less than 15%. We think that poor postoperative results in the 1980s may have been due to imperfect suture materials or poor selection of patients for the procedure. In addition, the indication for triangular resection of the anterior leaflet in a patient with anterior leaflet prolapse resulting from elongation or rupture of one or more chordae tendineae in a degenerative mitral valve cannot be compared with the anatomy and function of billowing and prolapsing "Barlow" valves.

Tanaka and Takeda report gradually progressive regurgitation with left ventricular dilatation 8 years after operation in their single patient. They discuss this worrisome appearance and the uncertainty about the exact histopathology of Barlow's valves, and suggest that there may be histological patterns similar to those of Marfan's syndrome [5], which could result in leaflet fragility, progression to redundancy again, and finally, recurrent mitral regurgitation.

Because of these considerations, we contacted the group of patients operated on between 1996 and 1998 [1] to verify the stability of the valve repair. We have not received any feedback regarding the progress of mitral valve regurgitation in these patients. However, in the near future, we will initiate a conclusive follow-up study to confirm the promising results of our original study.

References

1. Fasol R, Mahdjoobian K. Repair of mitral valve billowing and prolapse (Barlow): the surgical technique. Ann Thorac Surg. 2002;74:602–605[Abstract/Free Full Text]
2. Tanaka K, Furuse A, Kotsuka Y, et al. Mitral valve repair with extensive resection of the anterior leaflet for regurgitation due to Barlow's disease: Report of a case. Jpn Heart J. 1997;38:865–868[Medline]
3. Carpentier A. Cardiac valve surgery—the "French correction". J Thorac Cardiovasc Surg. 1983;86:323–327[Medline]
4. Bojar RM. Valvular heart disease, including hypertrophic cardiomyopathy. In: Adult cardiac surgery. Boston: Blackwell Scientific, 1992:202–215
5. Fornes P, Heudes D, Fuzellier JF, Tixier D, Bruneval P, Carpentier A. Correlation between clinical and histologic patterns of degenerative mitral valve insufficiency: a histomorphometric study of 130 excised segments. Cardiovasc Pathol. 1999;8:81–92[Medline]

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