Seeking a Higher Standard for Degenerative Mitral Valve Repair: Begin with Etiology

Etiologic comparison of degenerative mitral valve disease: Fibroelastic deficiency resulting in chordal rupture with single segment prolapse [P1] (a). This valve was repaired with a limited triangular resection and ring annuloplasty (b). In contrast, Barlow's disease (c) is characterized by multi-segment prolapse and marked excess tissue; repair technique included extensive resection, annular plication, sliding plasty, commisuroplasty and large ring annuloplasty (d).