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

Echocardiographic studies were performed in 190 consecutive patients with mitral valvular prolapse. All patients had either midsystolic posterior motion of the mitral valve or holosystolic hammock-like movement of the valve in systole. Thirteen patients (7 percent) were noted to have ruptured chordae tendineae. In four patients, a combination of abnormalities was observed. Five patients had clinical and bacteriologic evidence of infective endocarditis, two of whom had severe intractable pulmonary edema consequent to acute mitral regurgitation which required mitral valvular replacement. At surgery, one of these patients had ruptured chordae tendineae to both leaflets, and the other had chordal rupture of the posterior leaflet. The other patients probably had spontaneous rupture of the chordae tendineae. A spectrum of clinical findings was noted. Six patients had marked mitral regurgitation, while two had isolated systolic clicks. Thus, chordal rupture does not always result in severe hemodynamic deterioration. Serial echocardiographic studies will be of value in studying the natural history and progression of disease in patients with chordal rupture.
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PMID:Incidence of ruptured chordae tendineae in the mitral valvular prolapse syndrome: an echocardiographic study. 42 75

A heroin addict with asymmetric septal hypertrophy and persistent fungemia with Candida parapsilosis was treated with amphotericin B and flucytosine (5-fluorocytosine). The diagnosis of endocarditis was based on the subsequent development of a murmur of mitral regurgitation and echocardiographic evidence of prolapse of the posterior leaflet of the mitral valve. Cure was effected with antifungal therapy alone. Thus, when the diagnosis of fungal endocarditis is made early in its course, open-heart surgery may not be needed. To investigate the relative frequency of isolation of C parapsilosis from particular sites, a mycologic survey was conducted in our hospital. Among the isolates of yeasts, C parapsilosis represented 8.0, 17.1, and 26.7 percent of those from all cultured sites, from contaminated intravenous catheters, and from cultures of blood, respectively. Since this trend to cluster in cases of fungemia was not seen with other yeasts, C parapsilosis appears to be more invasive than other species of Candida.
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PMID:Successful medical therapy for endocarditis due to Candida parapsilosis. A clinical and epidemiologic study. 63 Sep 78

For half a century the systolic click and late systolic murmur lay dormant as innocent auscultatory curiosities. The thirteen years since Barlow related these phenomena to mitral leaflet prolapse have witnessed an astonishing information explosion. We have sought to bring together the accumulated data in this review. An Historical Perspective traces the evolution from the now abandoned "pericardial" or "extracardiac" phases, through the leafletchordal phase (redundancy), the myocardial phase (segmental left ventricular contraction abnormalities), to the anular phase (dilatation and faulty systolic contraction). Functional Anatomy is dealt with in terms of pathology, pathophysiology, hemodynamics, angiocardiography, echocardiography, and physical and pharmacological interventions. Clinical Manifestations are concerned with prevalence, natural history, symptoms, physical signs, electrocardiographic abnormalities and roentgen fingings. The four Major Complications- sudden death, infective endocarditis, spontaneous rupture of chordae tendineae, and progressive mitral regurgitation- are examined. Associated Cardiac Diseases, i.e., Marfan's syndrome, ostium secundum atrial septal defect and atherosclerotic coronary artery disease, are discussed, and a section on Treatment deals chiefly with prophylaxis for infective endocarditis and the management of arrhythmias and chest pain. A final section on Evolving Information considers etiologic concepts, the nature of left ventricular contration abnormalities, the cause of chest pain, the relationship to Marfan's syndrome and ostium secundum atrial septal defect, and the effect of aging and sex differences on leaflet chordal redundancy.
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PMID:Mitral valve prolapse. 77 40

Mitral valve prolapse is a condition that is being recognized with increased frequency. It is not known whether its incidence is increasing, or whether we are better able to diagnose it today. In the idiopathic or familial variety, the mitral valve pathology is almost always that of myxomatous degeneration. Some authors have suggested the presence of a cardiomyopathy because of significant left ventricular dysfunction in many cases. Idiopathic prolapse occurs predominantly in females, often at a young age, and may be associated with chest pain, dyspnea, fatigue, presyncope, syncope, and/or sudden death. The clinical findings are variable and typically consist of a nonejection click and/or late systolic murmur, heard best at the cardiac apex. Diagnosis can be confirmed by echocardiography and/or ventricular cineangiography, the latter permitting accurate recognition of the anatomy of the prolapsed leaflets. The complications of infective endocarditis, severe mitral insufficiency, and life-threatening ventricular arrhythmias represent the major problems of management. It is important to distinguish the idiopathic form of mitral valve prolapse from that due to coronary artery disease and to realize that mitral valve prolapse may occur in Marfan's syndrome, Turner's syndrome, or in association with secundum atrial septal defect or ruptured chordae tendineae. Typical clicks and/or murmurs have also been described in patients with a history of rheumatic fever and in hypertrophic cardiomyopathy. Although much descriptive knowledge has accumulated over the past 15 years, many unanswered questions remain regarding the idiopathic type of prolapse. What is the nature and cause(s) of myxomatous degeneration? What is the relation of the valve pathology to the left ventricular dysfunction? What is the relation of both of these factors to disabling chest pain, electrocardiographic changes, and life-threatening arrhythmias? Hopefully, answers to these and other important questions regarding mitral valve prolapse will be forthcoming.
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PMID:Mitral valve prolapse. 77 95

Serial echocardiograms of a patient with enterococcal endocarditis and aortic insufficiency suggested the presence of vegetations on the aortic valve with progression of the lesion to frank prolapse of an aortic valve cusp. At surgery, the patient was found to have a flail noncoronary cusp to which an 8 mm vegetation was adherent. Anatomic correlations are presented, and a possible mechanism for the unusual echographic findings is discussed.
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PMID:Echocardiographic appearance of ruptured aortic cusp. 83 82

In order to assess the reliability of the echocardiogram in detecting valvular vegetations in patients with mitral valve prolapse (MVP), echocardiograms from 85 consecutive patients with mitral valve prolapse were reviewed. Eleven patients had thick shaggy echoes confined to the anterior mitral leaflet; eighteen patients had shaggy echoes on the posterior leaflet; and five had abnormal echoes on both the anterior and posterior leaflets. Only one patient had clinical evidence of infective endocarditis. Redundant leaflets which present multiple surfaces for the production of echoes may explain the abnormal echoes that were observed. Patients with echographic features suggesting mild prolapse less commonly exhibited shaggy leaflet echoes than those with more severe prolapse. Because a significant proportion (40%) of patients with MVP had shaggy echoes which closely resembled those seen in valvular vegetations, we feel that the echocardiogram is of limited value in diagnosing infective endocarditis in patients with mitral valve prolapse.
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PMID:Limitations of the echocardiogram in diagnosing valvular vegetations in patients with mitral valve prolapse. 88 98

Between August 1969 and January 1976, 561 patients underwent homograft replacement of the aortic valve (AVR). Isolated AVR was performed in 339 patients, ranging in age between 18 months and 74 years. The valves were sterilized in antibiotic solution and preserved at 4 degrees C in tissue culture medium. There were 11 early deaths (3.2%) and 23 late deaths (6.8%). Actuarial analysis showed 88% survival at 5 years and 85% at 6 years. Valve failure occurred in 13 patients (3.8%) due to prolapse of one cusp in five patients (1.5%), infective endocarditis in three and degeneration of the graft in five (1.5%). Degenerative valve failure was encountered after the fourth year with an incidence of 3.5% of patients at risk, and occurred only in grafts from donors over the age of 70 years. Diastolic murmurs were present in 22% of patients followed up for more than one month and increased very slightly with time. The clinical result was judged to be good or excellent in approximately 90% of the surviving patients.
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PMID:The use of "fresh" unstented homograft valves for replacement of the aortic valve: analysis of 6 1/2 years experience. 91 46

In two patients who had been heroin users, loud midsystolic clicks developed during infective endocarditis involving the tricuspid valve. The sounds were loudest along the left sternal border, exhibited an increase in intensity during inspiration and were associated with right atrial gallop sounds and with murmurs of tricuspid regurgitation. This constellation of clinical events suggests that the midstystolic clicks emanated from tricuspid valve structures as a result of disordered function of the chordae tendineae. Prolapse of the tricuspid valve has recently been demonstrated angiographically to accompany similar abnormalities of mitral valve motion in certain patients with the click-murmur syndrome. The participation of the tricuspid valve in the generation of the auscultatory finding is unclear, but the cases herein reported suggest that the tricuspid valve is capable of producing these findings.
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PMID:Midsystolic clicks originiating from tricuspid valve structures: a sequela of heroin-induced endocarditis. 112 8

Homograft aortic valve replacement was performed in 311 patients at the tnational Heart thospital, London, between 1964 and 1973. Valve failure has occurred in 61 patients (20%), 32 of whom survived reoperation. From 1963 through 1967, 156 valves were freeze-dried and account for 56 of the valve failures. From 1968 to 1973, 118 fresh or fresh-frozen valves resulted in only 5 failures. Six general types of failure have been identified: calcification (13), dehiscence (15), infective endocarditis (17), prolapse (6), cusp degeneration (5), and tear or perforation (5). Valve failure may be due to surgical technical error resulting in dehiscence or valve incompetence, or it may be related to degenerative changes in the homograft. The clinical results, supported by gross and histological examination and viability testing, enable us to conclude that fresh or fresh-frozen valves are superior to freeze-dried valves, having resulted in only 4% valve failure over the past five years.
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PMID:Analysis of homograft valve failure in 311 patients followed up to 10 years. 116 72

A consecutive series of 912 surgically excised aortic valves was evaluated by means of macroscopic and histologic study. Pure aortic stenosis was diagnosed in 203 patients (p.) (22.25%), pure incompetence in 125 (13.72%) and combined dysfunction in 584 (64.03%). The diseases affecting the valves were: a) chronic rheumatic disease (593 p., 65%); b) dystrophic calcifications (214 p., 23%); c) noninflammatory aortic root disease (NIARD) and/or myxomatous infiltration of aortic cusps, floppy aortic valve (FAV) (55 p., 6%) d) infective endocarditis (50 p., 5.5%). Males outnumbered females with a ratio ranging from 2.4 (dystrophic calcific disease) to 1.6 (infective endocarditis). The mean age ranged from 37 +/- 7.5 (NIARD) to 61.2 +/- 6.3 (dystrophic calcific disease). Chronic rheumatic disease was the most frequent cause of stenoincompetence (542 p., 91.4%) while isolated stenosis was prevalently due to dystrophic calcification (172 p., 80.4%). The diseases causing isolated aortic incompetence were (in order of frequency): a) NIARD and/or FAV (55 p., 44%); b) infective endocarditis (50 p., 40%); and c) rheumatic disease (30 p., 16%). The 55 patients with NIARD and or FAV were divided into 3 groups: a) 23 p. with aortic root dilatation and normal cusps; b) 20 p. with aortic root dilatation and FAV; c) 12 p. with FAV but undilated aortic root. Aortic regurgitation was caused by cusp derangement in rheumatic disease (shortening, retraction) and infective endocarditis (perforations, erosions). Cusps diastasis and prolapse were the cause of regurgitation in aortic root dilatation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Surgical pathology of the aortic valve: a morphologic study on 912 surgically excised valves]. 129 12


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