Surgical treatment of mitral systolic click syndrome: results in 37 patients.

From 1974 to 1983, 37 symptomatic patients with mitral systolic click (Barlow's syndrome) underwent mitral valve repair. In 11 patients (30%), the click syndrome was associated with minor mitral regurgitation. Thirty-two patients (86%) had chest pain, 20 had arrhythmia (54%), and 20 had dyspnea as a major complaint. In 5 patients, the arrhythmia was serious, and in 2 of them, it was potentially life threatening. Mitral annuloplasty using a collar prosthesis was performed in 33 patients with posterior leaflet plication in 2, shortening of the chordae in 1, and commissural plication in 2. In 4 patients, commissural plication was performed. One of these patients also required cusp plication and shortening of the chordae, and another required repair of ruptured chordae. There were no operative or late cardiac-related deaths at a mean follow-up of 4.7 years (range, 1 to 10 years). Sixty-two percent of patients with prolapse alone and 91% of those with associated regurgitation were improved by at least one New York Heart Association Functional Class, with 60% of patients obtaining relief of one or more symptoms. In the presence of major symptoms, mitral annuloplasty offers symptomatic relief for some patients with mitral systolic click syndrome without valve incompetence, but it gives substantially better results in patients with mitral regurgitation.