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Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An accurate diagnosis of cardiac pathology using TEE is contingent upon the ability to recognize and differentiate normal cardiac structures and normal variants from pathologic conditions. We describe several normal cardiac structures commonly imaged using TEE of the atria, interatrial septum, aorta, valves, and extracardiac spaces that may mimic diverse pathologic states, such as intracardiac tumor and thrombus, valvular vegetations, mitral and tricuspid valve prolapse, atherosclerotic plaque, and aortic dissection. Methods to aid in the differentiation of normal cardiac structures from pathology are offered.
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PMID:Transesophageal echocardiography: normal variants and mimickers. 826 87

Clinical and necropsy findings are described in 56 patients with mitral valve prolapse: 15 patients, aged 16 to 69 years (mean 39), died suddenly and mitral valve prolapse was the only cardiac condition found at necropsy (hereafter called isolated mitral valve prolapse); the remaining 41 patients had other conditions that were capable of being fatal. Of the latter 41 patients, 7, aged 17 to 59 years (mean 45), had associated congenital heart disease, and 34 patients, aged 17 to 70 years (mean 52), had no associated congenital cardiac abnormalities. Compared with the 34 patients without associated congenital heart disease and with nonmitral valve prolapse conditions capable in themselves of being fatal, the 15 patients who died suddenly with isolated mitral valve prolapse were younger (mean age 39 +/- 17 versus 52 +/- 15 years; p = 0.01), more often women (67% versus 26%; p = 0.008) and had a lower frequency of mitral regurgitation (7% versus 38%; p = 0.02). The 15 patients dying suddenly with isolated mitral valve prolapse also were less likely to have evidence of ruptured chordae tendineae (29% versus 67%; p = 0.04). The frequency of increased heart weight (67% versus 59%), a dilated mitral valve anulus (80% versus 81%), a dilated tricuspid valve anulus (17% versus 17%), an elongated anterior mitral leaflet (86% versus 54%), an elongated posterior mitral leaflet (79% versus 77%) and fibrous endocardial plaque under the posterior mitral leaflet (73% versus 63%) was similar between the two groups. The severity of the prolapse (mild 20% versus 11%; moderate 27% versus 58%; severe 53% versus 32%) also was similar between the two groups. Thus, persons with mitral valve prolapse dying suddenly without another recognized condition tend to be relatively young women without mitral regurgitation.
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PMID:Morphologic comparison of patients with mitral valve prolapse who died suddenly with patients who died from severe valvular dysfunction or other conditions. 199 30

The varying hypotonia in Down syndrome is one of its most dramatic signs. In particular, the facial expression and oral dysfunctions of these handicapped persons are uniquely characteristic. The more-or-less permanently open mouth; the prolapse of the tongue, exposed on the everted lower lip; and a lack of mastication, deglutition and speech are primarily caused by the hypotonic orofacial muscles. Breathing through the mouth leads to a dehydration of bacteria and plaque on gums and teeth, and ultimately to premature destruction of the dentition. This developmental syndrome indicates the need for early functional training of the orofacial muscles. Oral Regulation Therapy as described by Castillo-Morales was applied to seventy-four children here, with encouraging results.
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PMID:Orofacial regulation therapy in children with Down syndrome, using the methods and appliances of Castillo-Morales. 214 26

Cardiac evaluation of stroke or transient ischemic attack (TIA) patients includes transthoracic and transesophageal echocardiography to identify potential cardiac source of embolism. In the present study transesophageal echocardiography was performed in 53 consecutive patients with non valvular atrial fibrillation and a previous embolic stroke. All patients were referred to our department because of an episode of atrial fibrillation. They all underwent computed tomography (CT) scan: 31 patients had a positive scan whereas 22 had a negative scan with a positive history of TIA diagnosed from a neurologist during hospitalization. In the group of 31 patients with a positive scan 9 patients with no history of a previous ischemic attack were found. The transesophageal echocardiography was performed in all the study subjects: 7 patients had a thrombus in the left atrial appendage, 2 patients had a thrombus in the right atrium. Spontaneous echo contrast was reported in 15 patients. Evaluating the interatrial septum we observed a patent foramen ovale in 4 patients, a defect in 2 patients and a fossa ovalis aneurysm in 3 patients. The mitral valve analysis showed a leaflet prolapse in 3 patients. The entire thoracic aorta was imaged in each patient: in 12 an abnormal atherosclerotic plaque was found. Transesophageal echocardiography is an important component of the comprehensive evaluation of potential sources of embolism in patients with ischemic cerebral attack and nonrheumatic atrial fibrillation.
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PMID:[Transesophageal echocardiography in the assessment of patients with atrial fibrillation and stroke]. 801 13

A 42-year-old housewife with myasthenia gravis (MG) for 22 years, who was initially treated by radiation to the hyperplastic thymus and anti-cholinesterase therapy, developed bilateral ptosis, paresthesia of her right face and decreased taste sensation after house work at the age of 42 years. Neurological examinations revealed lateral and vertical gaze palsy, upward nystagmus, decreased taste sensation, peripheral facial palsy on the left side. She also had hypalgesia on the right face, arm and chest up to Th7 level, and urinary retention. She had hyperreflexia on the right side but no extensor toe signs. CSF study revealed 5 cells/microliters and protein of 23 mg/dl. Serum IgG anticardiolipin antibody was positive. Magnetic resonance imaging studies revealed high intensity areas in the brainstem tegmentum and periventricular white matter. Diagnosis of multiple sclerosis (MS) was made. This is the first case in which MG, MS and serum anticardiolipin antibody were present simultaneously, which may be all due to some immunological abnormality. Steroid therapy made anti-cardiolipin antibody negative, but new MS plaque developed in 7 months, which favors diagnosis of MS rather than infarction, since the activities of ACLA were not correlating to clinical symptoms. MRI was helpful in detecting MS plaques in MG patients.
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PMID:[A case of myasthenia gravis associated with multiple sclerosis and positive anticardiolipin antibodies]. 836 70

Xanthoma palpebrarum is the most common form of xanthoma that appears in the eyelids. Usually there is no functional loss in the eyelids and plaque formation is typical. In this article, we present a patient who had xanthomatic masses that covered the whole upper eyelids. The masses caused a serious degree of ptosis in both upper eyelids. This patient was searched for systemic disease. After removal of the xanthoma palpebrarum, extensive ptosis has been relieved.
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PMID:Extensive bilateral eyelid ptosis caused by xanthoma palpebrarum. 904 89

It has been shown that the articulation site in the Palmaz-Schatz stent is a frequent site for restenosis. In this communication, we report on a new method to eliminate the articulation site in the Palmaz-Schatz stent to provide better lesion coverage and decrease the probability of plaque prolapse at the articulation site. We believe that this method is simple and effective, and that it serves an important clinical purpose.
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PMID:A method to eliminate articulation from the Palmaz-Schatz stent delivery system. 904 71

We report a 62-year-old man who developed coma and died in a fulminant course. The patient was well until May 1, 1996 when he noted chillness, tenderness in his shoulders, and he went to bed without having his lunch and dinner. In the early morning of May 2, his families found him unresponsive and snoring; he was brought into the ER of our hospital. He had histories of hypertension, gout, and hyperlipidemia since 42 years of the age. On admission, his blood pressure was 120/70, heart rate 102 and regular, and body temperature 36.3 degrees C. His respiration was regular and he was not cyanotic. Low pitch rhonchi was heard in his right lower lung field. Otherwise general physical examination was unremarkable. Neurologic examination revealed that he was somnolent and he was only able to respond to simple questions such as opening eyes and grasping the examiner's hand, but he was unable to respond verbally. The optic discs were flat; the right pupil was slightly larger than the left, but both reacted to light. He showed ptosis on the left side, conjugate deviation of eyes to the left, and right facial paresis. The oculocephalic response and the corneal reflex were present. His right extremities were paralyzed and did not respond to pain Deep tendon reflexes were exaggerated on the right side and the plantar response was extensor on the right. No meningeal signs were present. Laboratory examination revealed the following abnormalities; WBC 18,400/ml, GOT 131 IU/l GPT 50 IU/l, CK616 IU/l, BUN 30 mg/dl, Cr 2.1 mg/ dl, glucose 339 mg/dl, and CRP 27.4 mg/dl. ECG showed sinus tachycardia and ST elevation in II, III and a VF leads and abnormal q waves in I, V5, and V6 leads. Chest X-ray revealed cardiac enlargement but the lung fields were clear. Cranial CT scan revealed low density areas in the left middle cerebral and left posterior cerebral artery territories. The patient was treated with intravenous glycerol infusion and other supportive measures. At 2: 10 AM on May 3, he developed sudden hypotension and cardiopulmonary arrest. He was pronounced dead at 3:45 AM. The patient was discussed in a neurological CPC, and the chief discussant arrived at the conclusion that the patient had acute myocardial infarction involving the inferior and the true posterior walls and left internal carotid embolism from a mural thrombus. Post mortem examination revealed occlusion of the circumflex branch of the left coronary artery due to atherom plaque rupture and myocardial infarction involving the posterior and the lateral wall with a rupture in the postero-lateral wall. Marked atheromatous changes were seen in the left internal carotid, the middle cerebral and the basilar arteries; the left internal carotid and the middle cerebral arteries were almost occluded by thrombi and blood coagulate. The territories of the left middle cerebral and the occipital arteries were infarcted; but the left thalamic area was spared. The neuropathologist concluded that the infarction was thrombotic origin not an embolic one as the atherosclerotic changes were severe. Cardiac rupture appeared to be the cause of terminal sudden hypotension and cardiopulmonary arrest. It appears likely that a vegetation which had been attached to the aortic valve induced thromboembolic occlusion of the left internal carotid artery which had already been markedly sclerotic by atherosclerosis. It is also possible that the vegetations in the aortic valve came from mural thrombi at the site of acute myocardial infarction, as no bacteria were found in those vegetations.
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PMID:[A 62-year-old man with an acute onset of consciousness disturbances]. 945 48

The direct relationship between minor plaque prolapsed within stents and late in-stent restenosis is unknown. Therefore, we evaluated the impact of minor plaque prolapse on late angiographic in-stent restenosis. Intravascular ultrasonography (IVUS)-guided single-coronary stenting was successfully performed on 384 consecutive patients with 407 native coronary lesions. Six-month follow-up angiographic evaluation was performed on 315 patients (82. 0%) with 334 lesions (82.1%). Minor plaque prolapsed within the stent was found in 75 of 334 lesions (22.5%). Results were evaluated using angiographic and IVUS methods. The development of minor plaque prolapse was significantly associated with infarct-related artery (P = 0.000) and small pre-intervention minimal lumen diameter (P = 0. 001). The overall angiographic restenosis rate was 23.1% (77/334)-21.3% (16/75) in the lesions with plaque prolapse vs. 23.6% (61/259) in the lesions without plaque prolapse (P = 0.806). In conclusion, minor plaque prolapsed within stents might not be associated with late angiographic in-stent restenosis.
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PMID:Long-term outcomes of minor plaque prolapsed within stents documented with intravascular ultrasound. 1097 13

We studied the records of 175 consecutive patients referred to our neurologic ward between January 1994 and February 2000 with a diagnosis of ischaemic cerebrovascular disease (ICVD) (stroke or transient ischaemic attack - TIA) who underwent transoesophageal echocardiography (TEE). We excluded patients with large vessel disease, high-risk embolic cardiopathies and other rare causes of stroke. According to clinical and neuroimaging findings, patients were divided into two groups. The lacunar (LAC) group (69/175 (39.4%)) and the nonlacunar (N-LAC) one (106/175 (60.6%)). The control population consisted of 78 consecutive patients, referred to the echocardiography laboratory for TEE without history of ICVD and known heart disorders. Patent foramen ovale (PFO) frequency was significantly higher in case patients than in control subjects (55/175 (31.4%) vs. 13/78 (16.6%); p = 0.02). Among case patients, PFO was more prevalent in the N-LAC group than in the LAC one (43/106 (40.6%) vs. 12/69 (17.4%); p = 0.0005). A large degree of shunt occurred in 53.5% of N-LAC patients and in 16.7% of LAC ones (p = 0.04). Atrial septal aneurysm (ASA) was detected in 12% of case patients and 1.3% of control subjects (p = 0.003) and was more frequent in the N-LAC group than in the LAC one (16 vs. 5.8%; p = 0.05). Mitral prolapse (MP) was present in 6/175 (3.4%) ICVD patients (vs. 1/78 among controls) in most cases associated with myxomatous valve redundancy. Aortic arch atheromas (AA) were detected in 12% of ICVD patients and in 10.2% of controls. The frequency was 9.4% in N-LAC and 15.9 in LAC. No complicated AA (plaque thickness >4 mm, ulcerated atheroma, superimposed thrombus) were detected. After multivariate analysis, PFO (OR = 3.8; 95% CI = 2.7-7.9) and ASA (OR = 8.01; 95% CI = 3.0-16.1) appeared to be independent predictors of ICVD. PFO (OR = 2.24; 95% CI = 1.24-4.92) was also independently associated with N-LAC stroke subtype and its importance was even higher in younger patients. Our study provides further evidence that TEE is a helpful diagnostic tool in stroke patients without arterial and major cardiac sources of embolism. However, its utility differs according to type and localization of the ischaemic lesion being more relevant in patient with N-LAC infarctions.
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PMID:Transoesophageal echocardiography in patients without arterial and major cardiac sources of embolism: difference between stroke subtypes. 1191 34


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