Etiologic Classification of Degenerative Mitral Valve Disease: Barlow’s Disease and Fibroelastic Deficiency

Anyanwu, Ani C.; Adams, David H.

doi:10.1053/j.semtcvs.2007.04.002

Cited by 242 publications

(191 citation statements)

References 31 publications

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“…1). Under these conditions, commissural prolapse was more frequently observed in the 3D-TEE group than those in the 2D-TEE group, although there were no significant differences in number of patients with anterior and posterior leaflet prolapse, traditional Barlow's disease [17], and endocarditis.…”

Section: Patient Characteristicsmentioning

confidence: 76%

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Impact of real-time three-dimensional transesophageal echocardiography on procedural success for mitral valve repair

et al. 2015

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Background For mitral valve repair, minimally invasive cardiac surgery as well as transcatheter valvular intervention have been developed. Under these conditions, threedimensional transesophageal echocardiography (3D-TEE) plays a key role for planning the surgical treatment strategy. However, few data exist regarding the role of 3D-TEE in mitral valve repair. Therefore, we examined the impact of 3D-TEE on procedural success of mitral valve repair. Methods and resultsWe examined 86 consecutive patients who underwent mitral valve repair for degenerative mitral valve prolapse. Among them, 39 patients were examined by only two-dimensional transesophageal echocardiography (2D-TEE) and 47 patients underwent 3D-TEE in addition to 2D-TEE. The cardiac surgeons and physicians discussed the repair procedure preoperatively with the echocardiographic images. As a result, 18 patients of the 2D-TEE group and 37 patients of the 3D-TEE group underwent mitral valve repair by small thoracotomy including robotic approach. Simple repair was done in 21 with 2D-TEE and 21 with 3D-TEE and complex repair was done in 18 with 2D-TEE and 26 with 3D-TEE.Importantly, three patients with 2D-TEE before surgery had to undergo reoperation due to recurrent severe mitral regurgitation with dehiscence of the annuloplasty rings, although none with 3D-TEE did. Conclusions These results demonstrate that 3D-TEE is helpful in assessing the morphology of mitral apparatus and complexity of mitral valve repair, particularly in minimally invasive cardiac surgery including robotic ones. We would suggest that sonographers, cardiologists, and cardiac surgeons should be familiar with 3D-TEE and work together throughout the perioperative period for better outcomes.

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Section: Patient Characteristicsmentioning

confidence: 76%

“…Moreover, the number of patients with NYHA functional class III/IV were not different between two groups. As for the morphology of mitral valve prolapse, 74 patients had fibroelastic deficiency [17] (Fig. 1).…”

Section: Patient Characteristicsmentioning

confidence: 99%

Impact of real-time three-dimensional transesophageal echocardiography on procedural success for mitral valve repair

et al. 2015

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“…11,12 ( Figure 2) -There are two major phenotypes of the degenerative mitral valve disease/prolapse: a) fibroelastic deficiency and b) Barlow's disease. 13,14 Fibroelastic deficiency is usually seen in individuals older than 60 years. It is often characterized by single chordal rupture and prolapse of an isolated scallop, most commonly the P2.…”

Section: Mechanisms and Causes Of Mitral Regurgitationmentioning

confidence: 99%

Primary mitral valve regurgitation: Update and review

Apostolidou

Maslow

Poppas

2017

gcsp

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Mitral regurgitation is the second most common valvular disorder requiring surgical intervention worldwide. This review summarizes the current understanding of primary, degenerative mitral regurgitation with respect to etiology, comprehensive assessment, natural history and management. The new concept of staging of the valvular disorders, newer predictors of adverse and controversy of ‘‘watchful waiting’’ versus ‘‘early surgical intervention’’ for severe, asymptomatic, primary mitral regurgitation are addressed.

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“…It is often due to either Barlow's disease (myxomatous valve disease), mitral valve prolapse, or fibroelastic deficiency. 7 Rare causes of DMR include Marfan syndrome, Ehlers-Danlos syndrome, and osteogenesis imperfecta.…”

Section: Degenerative/primary Mitral Regurgitationmentioning

confidence: 99%

Percutaneous Treatment of Mitral Regurgitation: Present and Future

Athappan

Sorajja

Gössl

2017

Journal of the Minneapolis Heart Institute Foundation

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Mitral valve regurgitation poses a significant public health burden, with more than 3 million people in the US alone suffering from moderate or severe mitral valve regurgitation. Surgical correction with mitral valve repair or replacement is the mainstay of therapy. However, a significant proportion of elderly patients are not eligible for mitral valve repair or replacement due to prohibitive surgical risk from increased age, poor ventricular function, or associated comorbidities. Percutaneous mitral valve repair/ replacement techniques have been developed to fill this void. The most advanced percutaneous technique with the highest safety and efficacy to date is the edge-to-edge MitraClip repair system. The majority of other catheter-based mitral valve repair/ replacement devices are at early developmental stages, but have shown encouraging initial results in feasibility trials. Transcatheter mitral valve replacement holds promise to emerge as the leading transcatheter treatment of choice in the future. KEY WORDS degenerative MR, functional MR, MitraClip, TMVR n INTRODUCTIONMitral valve regurgitation (MR) poses a significant public health burden, with more than 3 million people in the US alone suffering from moderate or severe MR.1 Left untreated, chronic MR results in heart failure symptoms, left ventricular cavity dilation and systolic dysfunction, left atrial enlargement, atrial fibrillation (AF), and pulmonary hypertension. In patients with severe primary/degenerative MR, an early repair of the structural defect is crucial to avoid irreversible sequela.2 In patients with secondary/functional MR, optimal medical therapy is a key component in the treatment of the underlying cardiomyopathy and may provide relief from symptoms. However, unless the cardiomyopathy and secondary/functional MR improves significantly under therapy, surgical or interventional options need to be considered. 3 Surgical correction with mitral valve repair (MVRe) or replacement (MVR) remain the mainstay of therapy for primary and secondary MR. Even so, because of the invasive nature of open-heart surgery (OHS) and the frequent presence of comorbidities in this group, up to 50% of patients with severe MR may not be offered surgery.4 This is especially true for older patients with multiple comorbidities and those with impaired left ventricular function. As a result, percutaneous technology is poised to significantly alter the treatment paradigm for chronic MR. Percutaneous MVRe or MVR offers the potential benefit of decreased morbidity, improved recovery time, and shorter hospital stays compared with OHS. In this review we summarize the devices that have been developed for percutaneous transcatheter mitral valve repair or replacement and their preliminary clinical results. Anatomy of the Mitral Valve ComplexAn appreciation of the complex anatomy of the mitral valve is of importance to understand the challenges in development of percutaneous MVRe or MVR technologies and for selection of the most optimal repair/replacement technique.T...

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Etiologic Classification of Degenerative Mitral Valve Disease: Barlow’s Disease and Fibroelastic Deficiency

Cited by 242 publications

References 31 publications

Impact of real-time three-dimensional transesophageal echocardiography on procedural success for mitral valve repair

Impact of real-time three-dimensional transesophageal echocardiography on procedural success for mitral valve repair

Primary mitral valve regurgitation: Update and review

Percutaneous Treatment of Mitral Regurgitation: Present and Future

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