Current Discoveries and Interventions for Barlow's Disease

Myxomatous Mitral Valve Disease with Mitral Valve Prolapse and Mitral Annular Disjunction: Clinical and Functional Significance of the Coincidence

The morphological changes that occur in myxomatous mitral valve disease (MMVD) involve various components, ultimately leading to the impairment of mitral valve (MV) function. In this context, intrinsic mitral annular abnormalities are increasingly recognized, such as a mitral annular disjunction (MAD), a specific anatomical abnormality whereby there is a distinct separation between the mitral annulus and the left atrial wall and the basal portion of the posterolateral left ventricular myocardium. In recent years, several studies have suggested that MAD contributes to myxomatous degeneration of the mitral leaflets, and there is growing evidence that MAD is associated with ventricular arrhythmias and sudden cardiac death. In this review, the morphological characteristics of MAD and imaging tools for diagnosis will be described, and the clinical and functional aspects of the coincidence of MAD and myxomatous MVP will be discussed.

The Association Between Keratoconus and Mitral Valve Prolapse: A Meta-Analysis

Objective

The debate pertaining to the association between Keratoconus (KC) and Mitral Valve Prolapse (MVP) continues to occur among physicians. The results of cross-sectional studies attempting to present the co-existing prevalence of these two diseases remain indeterminate. We compiled the first meta-analysis to determine the pattern of prevalence between the two diseases.

Methods

Two separate literature searches for cross-sectional studies were performed for this meta-analysis. The first search encompassed finding literature comparing the prevalence of KC between patients with MVP and a control group. The second search pertained to finding studies comparing the prevalence of MVP patients with KC and a control group.

Results

Six studies reported the prevalence of MVP in patients with KC and a control group. The prevalence was 41.6% in patients with KC and 11.5% in patients without KC (OR = 7.06 [95% CI = 2.41-20.64]). There was a significant heterogeneity among the studies (I² = 84%). Two studies showed the prevalence of KC in patients with MVP and a control group. The prevalence was 17.0% in patients with KC and 2.9% in the control group (OR = 5.07 [95% CI = 1.08-23.83]). There was no heterogeneity within the analysis (I² = 0%).

Conclusion

There is a statistically significant co-existing prevalence between MVP and KC. Patients with KC are more likely to present with MVP, and patients with MVP are more likely to present with KC.

Three-dimensional echocardiography of mitral Barlow's disease with infective endocarditis: Perforations or cleft-like indentations?

Barlow's disease is a complicated form of degenerative mitral valve (MV) disease. Infective endocarditis (IE) often occurs on the basis of primary heart diseases and may be combined with valve perforations. Cleft-like indentations (CLIs) were suggested by Ring et al. in 2013. They are located at the inter-scallop position and involve at least one-half of the valve. Herein, we report a case of Barlow's disease combined with IE and CLIs, which was confirmed intra-operatively and by histopathological examination. The CLIs were misdiagnosed by two-dimensional transthoracic echocardiography as perforations, but rightly interpreted by preoperative three-dimensional echocardiography. The possibility of CLIs should be considered in the evaluation of mitral regurgitation caused by myxomatous MV diseases.

Repair of bileaflet prolapse in Barlow syndrome: The 4-chord technique

Barlow syndrome is a form of degenerative mitral valve (MV) disease found in a subset of patients with bileaflet prolapse. The hallmark of Barlow's disease includes excessive and billowing leaflet tissue caused by myxomatous tissue proliferation, elongated chordae, and pronounced annular dilatation. Surgical repair of patients with Barlow's disease is challenging due to the extent of the leaflet and annular abnormalities. Several techniques have been described to repair Barlow's MV including currently popular "non-resectional" approaches. Repair with neochordae has been associated with excellent results and includes the advantage of preserved leaflet mobility and a large surface of coaptation. We describe a simple approach to the use of neochordae to repair bileaflet prolapse in patients with Barlow syndrome and avoid systolic anterior motion.