Mitral valve reconstruction because of Barlow's disease with mitral insufficiency, perioperative SAM (systolic anterior motion)

The case report describes the hospitalization of a 26 year old male with M. Barlow. The mitral valvuloplasty was performed. However, the peroperative ultrasonographic finding documented prolapse of the anterior cusp of the mitral valve into the outflow tract of left ventricle. The surgery was supplemented with a suture of the A2-PA segments of mitral valve. The subsequent finding was satisfactory. No more serious postoperative complications were noted. The patient was admitted to outpatient care on the eighth postoperative day.

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26-year-old man
PA: no disease in history, no surgery procedures in history
FA: father treatment of arterial hypertension, mother treatment diabetes mellitus
PA: no drug history
AA: ibuprofen (oedema)
DA: ex-smoker (8-26-years-old; 15 per day), alcohol occasionally
SA: lives in an apartment, works in a shop office
AD: Asymptomatic patient, systolic murmur was diagnosed during preventive medical examination. Patient was sent to a cardiology clinic for investigation.

Laboratoty results:

Ambulatory investigations:
Transthoracic ECHO 14 months before surgery:
Mitral valve – both cusps redundantly myxomatously changed, prolapse in second half of systole, serious regurgitation; left ventricle (LV) is dilated: LVD 6,0cm, LVS 4,8 cm , LVEF 65%, left atrium also dilated

Investigation during hospitalization:
Transthoracic ECHO- mitral valve - both cusps redundantly myxomatously changed, prolapse in second half of systole, serious regurgitation, dilatation of mitral annulus - 4,5cm, volume of regurgitation more than 60 mL, LVD: 6,5, LVS: 4,5cm – dilated, volume overloaded, LVEF 45%, left atrium also dilated; Aortic valve - three cusps, physiologic; mitral valve – regurgitation through central area, A4C - LVESV 104 ml-, LVEDV 220ml , together SV 120ml - dilated, systolic dysfunction LVEF 45%, annulus of tricuspid valve <3,0cm, tricuspid regurgitation 1st. degree, max 3,0-3,5 m/s – soft post capillary pulmonary hypertension
Conclusion: Barlow's disease – myxomatous changing of both cusps of mitral valve, mitral regurgitation 3rd. degree, systolic disfunction of left ventricle LVESV 100ml, LVEF 45% , LA dilated, RA not dilated, Tricuspidal annulus not dilated, tr. reg. 1st. degree, soft post capillary pulmonary hypertension, pericardium without fluid

Lab. values: normal

Imaging methods:

ECG: SR fr. 54/min, normal electric axis, PQ interval 160ms, QRS 100ms, no ST elevation/depression, T wave negat III, aVR, aVF, V1

Coronarography: Left common coronary artery: without stenosis; LAD: without stenosis; circumflex artery: without stenosis; right coronary artery: without stenosis; Conclusion: negative coronarography.


Barlow's disease with mitral regurgitation 3rd. degree
Tricuspidal regurgitation 1st. degree
Left ventricle systolic dysfunction (LVEF 45%)

Therapy and conclusion:

Treatment strategy:
Surgery (reparation/replacement) of mitral valve indicated (MVr).

Surgery procedure:
Annulo et valvulo plastic surgery of mitral valve cum annuloplasty ring Physio No. 40, sutura A2-P2 – CPB: 90min, aortic clamping time: 59+18min.

Postoperative course:
Postoperative course complicated by pneumothorax (PNO). PNO spontaneously resorbed. On the 8th postoperative day released to outpatient care.


CPB – cardiopulmonary bypass; ECHO – echocardiography; LA – left atrium; LAD – left anterior descending artery; LVD – left ventricle diastolic diameter; LVEDV – left ventricle end diastolic volume; LVEF – left ventricle ejection fraction; LVESV – left ventricle end systolic volume; LVS – left ventricle systolic volume; MVr – mitral valve repair; PH – pulmonic hypertension; PNO – pneumothorax; RA – right atrium; RTG – X-ray picture; SR – sinus rhythm; SV – systolic volume

Authors declare the case report will not be published in any national or international publications.

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