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Published on: May 19, 2020
Etiologic classification of degenerative mitral valve disease: Barlow's disease and fibroelastic deficiency
1Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, New York 10029, USA.
Insights
Differentiating Barlow's disease and fibroelastic deficiency, the two main types of degenerative mitral valve disease, is crucial for surgical planning. Accurate preoperative assessment ensures appropriate techniques and surgeon expertise for successful mitral valve repair.
Area of Science:
- Cardiovascular Medicine
- Cardiac Surgery
- Echocardiography
Background:
- Degenerative mitral valve disease encompasses two primary forms: Barlow's disease and fibroelastic deficiency.
- These conditions exhibit distinct clinical and echocardiographic features.
- Accurate preoperative differentiation is essential for tailoring surgical approaches and optimizing repair outcomes.
Purpose of the Study:
- To elucidate the unique differentiating characteristics of Barlow's disease and fibroelastic deficiency.
- To emphasize the importance of preoperative differentiation for guiding surgical strategy and resource allocation.
- To provide insights for cardiologists and cardiac surgeons in managing these distinct mitral valve pathologies.
Main Methods:
- Review of clinical presentations and echocardiographic findings associated with Barlow's disease.
- Analysis of echocardiographic and clinical data for fibroelastic deficiency.
- Comparison of surgical repair techniques and outcomes based on etiological subset.
Main Results:
- Barlow's disease often presents with multiple complex lesions requiring specialized expertise for successful repair.
- Fibroelastic deficiency typically involves less complex pathology, amenable to repair by experienced general cardiac surgeons.
- Preoperative differentiation impacts the likelihood of achieving high mitral valve repair rates.
Conclusions:
- Distinguishing between Barlow's disease and fibroelastic deficiency is critical for effective mitral valve repair.
- Reference mitral valve repair surgeons are best suited for complex Barlow's disease cases.
- Experienced general cardiac surgeons can achieve high repair rates for fibroelastic deficiency.
Abstract:
Barlow's disease and fibroelastic deficiency are the two dominant forms of degenerative mitral valve disease and have unique differentiating characteristics on clinical and echocardiographic assessment. Preoperative differentiation of patients by both cardiologists and surgeons is important because the techniques, surgical skill, and expertise required to achieve a repair vary among these etiological subsets. Barlow's patients often have multiple complex lesions, thus high rates of repair are only likely to be achieved by a reference mitral valve repair surgeon. In contrast, many forms of fibroelastic disease should be repaired at a high rate by experienced general cardiac surgeons. In this article, we highlight the differentiation of Barlow's disease and fibroelastic deficiency.
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