Barlow disease: Simple and complex

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Barlow disease: Simple and complex Gerald M. Lawrie, MD The Journal of Thoracic and Cardiovascular Surgery Volume 150, Issue 5, Pages 1078-1081 (November 2015) DOI: 10.1016/j.jtcvs.2015.09.030 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Three-chamber cardiac magnetic resonance images of severe Barlow disease. 1, Preoperative diastole. Mitral anteroposterior annular dimension is 58 mm. p, Tip of papillary muscles. 2, Preoperative late systole. The large mitral leaflets lie stretched across the dilated flattened mitral annulus and have no zone of coaptation. The entire leaflets are prolapsed above the plane of the annulus. The papillary muscles and left ventricular inferior wall are displaced upward. 3, Postoperative diastole. A 37-mm fully flexible ring has been inserted. 4, Postoperative late systole. The mitral leaflets slope down into the left ventricle and have a good zone of coaptation (15 mm). The left ventricular outflow tract dimensions are preserved. There is no systolic anterior motion. Papillary muscle and inferior wall motion are preserved. No leaflet resection was performed. LVOT, Left ventricular outflow tract. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1078-1081DOI: (10.1016/j.jtcvs.2015.09.030) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Intraoperative appearance of Barlow disease. The leaflets are large and billowing. All leaflet segments are affected. The chordae are elongated. The annulus is severely enlarged. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1078-1081DOI: (10.1016/j.jtcvs.2015.09.030) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 This figure shows a normal valve for reference (A) and the important differences between true Barlow disease with leaflet billowing and annular dilatation (B) and the functionally different condition of mitral valve prolapse (D-H). In some cases, Barlow disease is complicated by associated mitral valve prolapse (C). (Reproduced with permission from Barlow JB, Pocock WA. Billowing, floppy, prolapsed or flail mitral valves? Am J Cardiol. 1985;55:501-2.) The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1078-1081DOI: (10.1016/j.jtcvs.2015.09.030) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Three-chamber cardiac magnetic resonance images of severe Barlow disease. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1078-1081DOI: (10.1016/j.jtcvs.2015.09.030) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions