Barlow’s mitral valve disease: understanding the condition and treatment options
Barlow’s mitral valve disease is a condition affecting the heart’s mitral valve, which plays a vital role in controlling blood flow between the left atrium and left ventricle. While it can sometimes remain symptom-free, it may lead to complications such as mitral valve regurgitation, where blood leaks backward into the atrium.
In this article, consultant cardiothoracic surgeon Mr Max Baghai will guide you through the causes, symptoms, diagnosis, and treatment options of Barlow’s mitral valve disease.
What is Barlow’s mitral valve disease?
Barlow’s disease is a specific type of mitral valve prolapse, named after Dr John Barlow. In this condition, the mitral valve leaflets become thickened, enlarged, and excessively flexible. This can cause the valve to bulge backward (prolapse) into the left atrium when the heart contracts.
Key features
- Thickened, redundant mitral valve leaflets.
- Elongated or stretched chordae (the tendinous cords that anchor the valve).
- Potential mitral valve regurgitation.
Although it can occur in anyone, it is most often diagnosed in adults and may have a genetic component.
Symptoms to watch for
Many people with Barlow’s disease remain symptom-free, particularly in the early stages. When symptoms do appear, they can include:
- Palpitations or irregular heartbeat.
- Shortness of breath, especially on exertion.
- Fatigue.
- Chest discomfort.
It’s important to note that the severity of symptoms does not always match the degree of valve abnormality. Some patients may have significant valve changes but feel entirely well.
How is Barlow’s mitral valve disease diagnosed?
Diagnosis usually begins with a physical examination, during which a doctor may detect a characteristic heart murmur. The following investigations are commonly used:
Echocardiography
An ultrasound scan of the heart provides detailed images of the mitral valve’s structure and movement. This is the primary tool for diagnosing Barlow’s disease and assessing the severity of mitral valve regurgitation.
Electrocardiogram (ECG) and Holter monitoring
These tests record the heart’s electrical activity and can detect arrhythmias, which may occur in some patients with Barlow’s disease.
Cardiac MRI
In certain cases, a cardiac MRI may be used to get more precise images of the mitral valve and surrounding heart structures.
Treatment options
Treatment depends on the severity of mitral valve dysfunction and the presence of symptoms.
Conservative management
For mild cases without significant mitral valve regurgitation, regular monitoring and lifestyle adjustments are usually sufficient. This may include avoiding stimulants, managing blood pressure, and attending regular follow-ups.
Surgical intervention
When mitral valve regurgitation becomes significant or symptoms develop, surgery may be required. Mitral valve repair is preferred over replacement whenever possible, as it preserves heart function and carries lower long-term risks. Techniques may include:
- Reshaping or trimming the mitral valve leaflets.
- Reinforcing the valve with a supportive ring.
- Repairing or replacing stretched chordae.
Surgery is typically highly successful, especially when performed in specialised centres.
Barlow’s mitral valve disease is a manageable condition when properly diagnosed and monitored. Understanding the condition and maintaining regular check-ups with a cardiologist are key to ensuring long-term heart health.