What is Barlow’s Syndrome?
Barlow’s Syndrome, (a.k.a. Floppy-valve Syndrome or Mitral Valve Prolapse or Billowing Mitral Valve Syndrome or Click-murmur Syndrome or Myxomatous Mitral Valve Disease) is a common condition which is caused by improper closure of the mitral valve (the valve present between the left atrium and the left ventricle of the heart). It occurs when the leaflet of the mitral valve protrudes into the left atrium during the contraction of the heart. The valves ensure the flow of blood in the forward direction. The improper closing of the mitral valve causes blood leakage backwards into the left atrium (regurgitation).
This condition generally occurs in the patients with Marfan’s syndrome, Graves’ disease or rheumatic heart disease. In India, more than 10 million Barlow’s syndrome cases are reported every year. Most of the cases do not require treatment. However, few cases are life-threatening, and it may require medications and surgeries.
What causes Barlow’s syndrome?
The major cause of valve prolapse is degeneration of valvular tissue which causes the leaflets of the valve to stretch and enlarge. This in turn causes a bulge into the left atrium that restricts the valve to close properly.
Apart from tissue degeneration, functional mitral valve prolapse may also occur due to conditions such as:
- Myocardial ischemia
- Dilated cardiomyopathy
- Hypertrophic cardiomyopathy
What are the Risk factors of Barlow’s Syndrome?
Few health conditions may increase the person’s risk of developing Barlow’s syndrome. The conditions include:
- Graves’ Disease
- Ebstein’s Anomaly
- Marfan Syndrome
- Muscular Dystrophy
- Ehlers-Danlos Syndrome
What are the Symptoms associated with Barlow’s Syndrome?
Mostly the patients with Barlow’s syndrome do not experience any symptoms. However, some patients may exhibit symptoms which may include:
- Irregular heartbeat (arrhythmia)
- Migraine (one sided head ache, accompanied with nausea)
- Dyspnea (shortness of breath)
- Chest pain
- Syncope (fainting)
- Low blood pressure in lying position (orthostatic hypotension)
- Panic attacks
What are the complications of Barlow’s syndrome?
In most cases, patients with Barlow’s syndrome do not have any complications. In certain cases, complications may occur which includes:
1. Mitral valve regurgitation: Mitral valve regurgitation is the most common complication in which the blood flows back to the left atrium. The risk of mitral valve regurgitation is more in males and also in the patients with high blood pressure. This may further lead to stroke if not treated.
2. Arrhythmias: Irregular Heart Rhythms occur in people with Barlow’s syndrome, arrhythmias usually occur in the upper chambers of the heart; affecting the blood flow through the heart. However, these are not life-threatening but may be bothersome.
3. Endocarditis: A thin membrane called endocardium lines the heart valves. Infection in the endocardium is called as endocarditis. The risk of developing endocarditis is high in the older aged individuals and in individuals who have abnormal mitral valve.
How to Diagnose Barlow’s Syndrome?
For diagnosing Barlow’s syndrome, the doctor initially check for the heart sounds to rule out any clicking sounds that may be indicative of Barlow’s syndrome. It also allows the doctor to detect the presence of mitral valve regurgitation.
Other tests to diagnose Barlow’s syndrome may include:
Echocardiogram: An echocardiogram is a diagnostic procedure that evaluates the heart. In this procedure, high-frequency sound waves are utilized to create the images of the structures of the patient’s heart. It helps to evaluate the blood flow through the mitral valve and the amount of regurgitation (blood leakage).
Electrocardiogram (ECG): ECG is a non-invasive diagnostic test which uses electrodes for determining the electrical and the muscular activity of the heart. The electrical signals recorded help the physician in determining defects in the structure and rhythm of the heart.
Chest X-ray: A chest X-ray gives the image of the vital organs such as heart, lungs and also the blood vessels. It detects heart enlargements.
Coronary Angiogram: Coronary Angiogram is a specialized X-ray technique for the coronary artery. It is not a diagnostic tool for mitral valve prolapse, but it can detect it when it is done to detect some other conditions.
Stress Test: A stress test is performed to determine if there is mitral valve regurgitation that restricts the ability of the patient to exercise. In this test, the patient has to exercise or take medications under doctor’s supervision to increase the pulse rate to make the heart work more. A stress test is also effective in determining the presence of coronary heart disease.
What is the Treatment for Barlow’s Syndrome?
In few cases, when the patient has developed mitral valve regurgitation the physician may prescribe medications but if the patient‘s condition does not respond to medications, the physician may recommend a surgery.
Medications: Medications are prescribed by the physician when an individual develops symptoms of mitral valve regurgitation. Some commonly prescribed medication includes beta-blockers, aspirin, diuretics, blood thinners and anti-arrhythmic medications.
Surgery: Surgery is the preferred option for treatment when the patient has mitral valve regurgitations, with or without symptoms. The various approaches used in surgery are repair or replacement of valves.
- Valve Repair: This is a preferred approach in most of the cases of mitral valve regurgitations. The mitral valve has two flaps; a ring like structure called as annulus connects the leaflets to the heart muscle. The valve is repaired by reconnecting the leaflets of the valve or by excision of the excess mass to facilitate the tight closing of the leaflets. Sometimes the valve is also repaired by replacing or reinforcing the annulus.
- Valve Replacement: Valve replacement is done in few cases when repairing the valve is not a feasible option. It involves replacement of the damaged valve by prosthetic or artificial valve. Artificial valves are of two types viz, tissue valves and mechanical valves (made from animal tissue). Mechanical valves last longer, and the individual has to take anti-coagulant medication throughout their life. Tissue valves wear out easily. However, for patients who opt for the tissue valve, he/ she do not have to take anti-coagulant medication.