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Evolution from mitral annular dysfunction to severe mitral regurgitation in Barlow's disease
Yasmine L Hiemstra1, Anton Tomsic2, Paola Gripari3
1Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands.
Interactive Cardiovascular and Thoracic Surgery
|December 28, 2020
Summary
Mitral valve annular abnormalities in Barlow's disease are present early and worsen over time, preceding significant mitral regurgitation. These findings highlight the annulus as a key factor in disease progression and a target for surgical intervention.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Barlow's disease (BD) involves thickened, redundant mitral valve (MV) leaflets causing mitral regurgitation (MR).
- MV annular abnormalities are increasingly recognized as a potential primary pathology in BD.
- Leaflet thickening may be secondary to stress from annular abnormalities.
Purpose of the Study:
- To assess the temporal evolution of MV abnormalities in patients with Barlow's disease.
- To investigate the role of MV annular abnormalities in the pathophysiology of BD.
- To identify potential targets for surgical treatment in BD.
Main Methods:
- Analysis of 186 transthoracic echocardiograms (TTEs) from 64 patients with BD undergoing MV surgery.
- Assessment of MV leaflet and annular characteristics over a median follow-up of 4.2 years.
- Comparison of baseline characteristics between patients with different grades of MR.
Main Results:
- Patients with BD showed larger MV leaflet dimensions and annular diameter compared to healthy controls.
- Significant MV annular abnormalities, including outward motion and disjunction, were common in BD.
- Over time, MV annulus diameter, leaflet length, and billowing height increased significantly, correlating with worsening MR grade.
Conclusions:
- MV annulus abnormalities are present early in Barlow's disease and precede significant MR.
- These annular abnormalities play a substantial role in BD pathophysiology.
- The MV annulus represents an important target for surgical treatment in BD.
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