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Barlow Disease MV Repair — EECC MCQ

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HardValvular Heart DiseaseBarlow Disease MV RepairEECC

A 45-year-old man with severe mitral regurgitation due to Barlow disease (bileaflet prolapse with excess tissue) is evaluated for surgery. Echocardiography shows both anterior and posterior leaflet prolapse. What repair technique is most likely needed?

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Correct answer: B — Complex repair involving multiple techniques — neochordae, leaflet resection, sliding annuloplasty, edge-to-edge repair, and a rigid annuloplasty ring — performed at a dedicated MV repair reference centre

Barlow disease is characterised by excess valvular tissue, bileaflet prolapse, elongated chordae, and annular dilatation — the most complex form of degenerative MV disease to repair. Unlike simple P2 prolapse (which can be repaired with a single technique), Barlow disease typically requires a combination: (1) posterior leaflet resection/sliding plasty to reduce excess tissue height; (2) anterior leaflet neochordae (Gore-Tex artificial chordae) to correct prolapse; (3) commissural repair; (4) undersized rigid annuloplasty ring to correct severe annular dilatation. The 2025 ESC VHD Guidelines emphasise that complex MV repair should be performed at reference centres with high repair volumes (>25 MV repairs/year per surgeon) and documented repair rates >95% for degenerative MR. Barlow repair at non-expert centres has lower success rates.

Reference: ESC/EACTS (2025): VHD Guidelines