AMA Category 1 Credit for Physicians Only.
ASRT CME is not available.
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This case is an example of Barlow's syndrome. Barlow's syndrome was named after JB Barlow who describe a "click-murmur" syndrome in 1966 and later became known as mitral valve prolapse (MVP). Barlow's syndrome can progress to involve both leaflets where both leaflets prolapse and a mitral valve regurgitation is present. The leaflets are redundant and thickened. Up to 40% of theses patients have a dysautonomia where there is a flight or flight response to emotional triggers.
Barlow valves can be repaired or replaced. When compared to fibroelastic disease, Barlow valves have a higher incidence of recurence rate of reoperation for mitral regurgitation (6% versus 2.6%). If chordal shortening, an annuloplasty ring, and a sliding annuloplasty were utilized in the Barlow valves, the recurrence rate was the same for reoperation for mitral regurgitation.
One study showed that a quadrangular resection of the posterior middle scallop and a triangular resection of the anterior scallop, a sliding valvuloplasty and a fold valvuloplasty of the lateral scallops had excellent results where there were no reoperations for mitral regurgitation after about 2 years of follow up.
However, other physicians from CTSNet feel that Barlows disease can only be successfully treated with gortex sutures (or similar) rather than resection. Their results have claimed a 2% reoperation rate for mitral regurgitation.
Another option is to perform an Edge-to-Edge repair on the Barlow valve. Reults of the Edge-to-Edge repair show a 9% reoperation rate for mitral regurgitation.
As far as the echo is concerned, the TEE shows a Barlow's valve (anterior and posterior prolapse with a P3 flail scallop. In some of the views, the amount of prolapse is obvious, but, in the 3D view, the amount of anterior prolapse is certianly less than the posterior prolapse.
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Mitral valve billow and prolapse: a brief review at 45 years - with reference to : mitral valve billowing and prolapse : perspective at 25 years.
Durability of mitral valve repair in Barlow disease versus fibroelastic deficiency.,
Repair of mitral valve billowing and prolapse (Barlow): the surgical technique.
Mitral Valve Repair for Barlows Syndrome using Adjustable Artificial Chordal Replacement,
Is recurrence of mitral valve regurgitation more frequent in Barlow Disease than in Fibroelastic Deficiency postrepair ? ,
The edge-to-edge repair