Midterm outcomes of quadrangular versus butterfly resection in mitral valve repair for Barlow’s disease

Q: What clinical and echocardiographic outcomes were compared between QR and BR in Barlow’s disease?

The study compared mid-term clinical outcomes and echocardiographic parameters, including NYHA functional class, mitral regurgitation severity, and left ventricular dimensions.

Q: How was the patient cohort evaluated and during which time points?

Patients were assessed using transthoracic and transesophageal echocardiography before surgery, during the procedure, and at mid-term follow-up.

Q: What advantages did the BR technique show over QR?

BR demonstrated significantly improved posterior leaflet mobility and a lower mean mitral valve gradient, with reduced coaptation depth indicating more annular-level coaptation.

Sep 29, 2026

Upload by Emma Wilson

Background: This retrospective study compares mid-term clinical and echocardiographic outcomes of quadrangular resection (QR) versus butterfly resection (BR) in isolated posterior leaflet prolapse and/or chordal rupture due to Barlow’s disease. Methods: Between May 2009 and January 2023, 142 patients undergoing mitral valve repair (QR n=69, BR n=73) were evaluated with transthoracic and transesophageal echocardiography preoperatively, intraoperatively, and at mid-term follow-up. Results: Both techniques improved NYHA class, mitral regurgitation severity, and left ventricular dimensions; BR showed superior posterior leaflet mobility and lower mean mitral valve gradient with reduced coaptation depth. Conclusion: BR is feasible, effective, and anatomically favorable, preserving leaflet mobility and minimizing gradients, especially in complex anatomies.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

ÖZ (Turkish Abstract)

Amaç

Çalışma planı

Bulgular

Sonuç

Study Citation and Publication Details

Turkish Journal of Thoracic and Cardiovascular Surgery 2025;33(4):401-411 Orıgınal Artıcle / Özgün Makale Midterm outcomes of quadrangular versus butterfly resection in mitral valve repair for Barlow’s disease Barlow hastalığında mitral kapak onarımında kuadrangüler ve butterfly rezeksiyonun orta dönem son uçları Gökhan Lafçı1,2􀀬, Ömer Faruk Çiçek3􀀬, Serkan Mola1􀀬, Emrah Ereren2􀀬, İlker Hasan Karal2􀀬, Hüseyin Ağırbaş2􀀬, Ayşe Lafçı4􀀬, Göktan Aşkın1􀀬, Garip Altıntaş1􀀬, Şeref Alp Küçüker1􀀬 Institution where the research was done: Ankara Bilkent City Hospital, Ankara, Türkiye and Samsun University Faculty of Medicine, Samsun, Türkiye Author Affiliations: 1Department of Cardiovascular Surgery, Ankara Bilkent City Hospital, Ankara , Türkiye 2Department of Cardiovascular Surgery, Samsun University Faculty of Medicine, Samsun, Türkiye 3Department of Cardiovascular Surgery, Selçuk University Faculty of Medicine, Konya, Türkiye 4Department of Anesthesiology and Reanimation, Ankara Bilkent City Hospital, Ankara, Türkiye ABSTRACT Background: This study aims to compare the mid-term clinical and echocardiographic outcomes of quadrangular resection (QR) and butterfly resection (BR) techniques in patients with isolated posterior leaflet prolapse and/or chordal rupture due to Barlow’s disease. Methods: Between May 2009 and January 2023, a total of 142 patients (89 males, 53 females; mean age: 56.6±11.9 years; range, 20 to 84 years) who underwent mitral valve repair with either QR (n=69) or BR (n=73) were retrospectively analyzed. Patients were evaluated using transthoracic and transesophageal echocardiography preoperatively, intraoperatively, and during mid-term follow-up. Clinical variables, echocardiographic parameters, and surgical data were compared between groups. Results: Baseline characteristics and preoperative echocardiographic findings were similar between the two groups. Both techniques resulted in significant improvements in the New York Heart Association functional class, mitral regurgitation severity, and left ventricular dimensions. However, the BR group demonstrated significantly improved posterior leaflet mobility (Wilkins score 1.97±0.74 vs. 3.23±0.79; p<0.001) and lower mean mitral valve gradient (3 [range, 2 to 4] vs. 6 [range, 5 to 7] mmHg; p<0.001) . Coaptation depth was also significantly reduced in the BR group, indicating a more annular-level coaptation. Conclusion: Butterfly resection is a technically feasible, effective, and anatomically favorable technique for mitral valve repair in Barlow’s disease. Its ability to preserve leaflet mobility and minimize mitral gradients makes it a valuable addition to the surgical armamentarium, particularly in anatomically complex cases. Keywords: Barlow’s syndrome. mitral valve, mitral valve insufficiency, treatment outcome, surgery. ÖZ Amaç: Bu çalışmada, Barlow hastalığına bağlı izole posterior leaflet prolapsusu ve/veya korda rüptürü olan hastalarda kuadrangülerrezeksiyon (KR) ve butterfly rezeksiyon (BR) tekniklerinin ortadönem klinik ve ekokardiyografik sonuçları karşılaştırıldı . Çalışma planı: Mayıs 2009 - Ocak 2023 arasında KR (n=69) veya BR (n=73) ile mitral kapak onarımı yapılan toplam 142 hasta (89 erkek, 53 kadın; ort . yaş: 56.6±11.9 yıl; dağılım, 20-84 yıl) retrospektif olarak incelendi. Hastalar ameliyat öncesi, ameliyat sırası ve orta dönem takiplerinde transtorasik ve transözofageal ekokardiyografi ile değerlendirildi. Klinikdeğişkenler, ekokardiyografik parametreler ve cerrahi verilergruplar arasında karşılaştırıldı . Bulgular: Gruplar arasında başlangıç özellikleri ve ameliyat öncesiekokardiyografik bulgular benzerdi. Her iki teknikte de New York Kalp Derneği fonksiyonel kapasite, mitral yetmezlik derecesive sol ventrikül boyutlarında anlamlı iyileşme sağlandı . Ancak BR grubunda posterior leaflet mobilitesi anlamlı derecede dahaiyi (Wilkins skoru 1.97±0.74’e kıyasla 3.23±0.79; p<0.001) ve ortalama mitral kapak gradiyent

FAQs

What clinical and echocardiographic outcomes were compared between QR and BR in Barlow’s disease?

The study compared mid-term clinical outcomes and echocardiographic parameters, including NYHA functional class, mitral regurgitation severity, and left ventricular dimensions.

How was the patient cohort evaluated and during which time points?

Patients were assessed using transthoracic and transesophageal echocardiography before surgery, during the procedure, and at mid-term follow-up.

What advantages did the BR technique show over QR?

BR demonstrated significantly improved posterior leaflet mobility and a lower mean mitral valve gradient, with reduced coaptation depth indicating more annular-level coaptation.

Sep 29, 2026

Upload by Emma Wilson