This Mitral Foundation Teaching Library case is going to demonstrate sliding leaflet plasty in combination with annular plication to treat a patient with a Barlow's malformation.

Our main strategy for treating patients with excess posterior leaflet tissue is sliding leaflet plasty. We follow Carpentier's rules, usually performing a limited quadrangular resection. We do resect less tissue today than we did historically, and then we reattach the leaflet along the annulus. Annular plication is sometimes used to narrow the orifice and take tension off the leaflet.