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

Thirty-five consecutive patients with systemic lupus erythematosus were enrolled in a prospective study. Investigations included a physical evaluation, tests for antinuclear antibodies and antiphospholipid antibodies, an electrocardiogram, a plain chest film, a 2D echocardiogram and a Doppler study. Clinical cardiac manifestations and alterations of the electrocardiogram were infrequent (17% and 11% of patients, respectively) and no patients had abnormal chest film findings. In contrast, echocardiographic abnormalities were common (82% of patients), although moderate in most instances. Pericardial involvement was found in 15 patients (42.8%); a pericardial effusion was seen in 9 of the 14 patients with inactive disease (p < 0.003), whereas thickening of the pericardium was visible in 4 patients with active disease and 2 of the 21 patients with inactive disease. Valve abnormalities were found in 17 patients (48.5%), but were not related to the presence of antiphospholipid antibodies; valve alterations included verrucous endocarditis in one case, valve thickening in one case, mitral prolapse in five cases, and mild or moderate regurgitation in 15 cases (aortic in 2 cases, mitral in 7 cases, pulmonary in 3 cases and tricuspid in 7 cases). Alterations in ventricular chamber size and kinetics were also fairly common, albeit of uncertain pathogenetic significance. These data confirm the value of 2D echocardiography for identifying and monitoring cardiac involvement in systemic lupus erythematosus, even in patients with no overt clinical manifestations.
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PMID:[Evaluation of cardiac involvement in systemic lupus erythematosus. Clinical and echographic study]. 130 69

Three decades after it was demonstrated that nonejection systolic clicks and late systolic murmurs have a mitral valve origin and that a specific syndrome is associated with the primary degenerative mitral lesion, numerous questions remain unanswered. A principal cause of confusion is the use of the term 'prolapse', which essentially implies a pathological state, in many patients with minimal evidence of a mitral valve anomaly. It should be recognised that no specific feature, whether evaluated by high standard echocardiography or indeed by careful morphological and histological examination, can be defined which distinguishes a normal variant from a pathological valve. There is a gradation from the normal billowing during ventricular systole of mitral leaflet bodies to marked billowing. With advanced billowing or floppy leaflets, failure of leaflet edge apposition supervenes (true prolapse). This is functionally abnormal and allows mitral regurgitation. Prolapse in turn may progress to a flail leaflet and hence gross regurgitation. Relatively rare complications of this degenerative mitral valve anomaly include systemic emboli, infective endocarditis, arrhythmias and, arguably, autonomic nervous system abnormalities. An attempt is made to clarify the management of some symptoms and other aspects of mitral prolapse-including rheumatic anterior leaflet prolapse (without billowing) which remains prevalent in South Africa and Third World countries.
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PMID:Mitral valve billowing and prolapse--an overview. 144 36

Echocardiography plays a major role in the management of patients with mitral valve prolapse (MVP). The technique has greatly enhanced our understanding of the pathophysiology, epidemiology and natural history. There are major and minor echocardiographic diagnostic criteria for prolapse. Major criteria involve the mitral leaflets and include late systolic posterior displacement on M-mode, bulging into the left atrium on 2D long-axis (LAX) view, and thickening and redundancy of the leaflets. Minor criteria include holosystolic posterior prolapse on M-mode, bowing of the mitral leaflets into the left atrium (LA) in the apical 2D views, and late systolic mitral regurgitation on the Doppler echogram. Any of the major criteria should be sufficient to make the diagnosis. One or two minor criteria without a major sign would be questionable. The degree of thickening and redundancy and the presence and quantitation of mitral regurgitation influence prognosis. Echocardiography is also helpful in identifying complications such as endocarditis and ruptured chordae. An echocardiogram may not be necessary for the diagnosis, but it is helpful for prognosis and as a baseline for possible future changes. The frequency of follow-up echocardiograms should be determined by clinical findings. When mitral regurgitation is present, then one should follow LA and left ventricular size and function. Transoesophageal echocardiography may be desirable for better definition of vegetations or flail leaflets and is frequently used to monitor surgical repair.
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PMID:Echocardiography in the management of mitral valve prolapse. 144 37

The clinical value of biplane transesophageal echocardiography (TEE) was assessed on basis of the experience of the first 100 cases. All studies were performed in awake patients, there was no complication or failure. There wee 43 males and 57 females, aged between 13 and 82 years. The indication of TEE was infective endocarditis in 33, congenital heart disease in 25, suspected tumor or thrombus in 18, search for source of embolism in 9, thoracic aortic pathology in 9, prosthetic valve dysfunction in 3 and other problems in 3 cases. Biplane technique provided additional information as compared to single plane TEE in the diagnosis of infective endocarditis (by the visualization of small vegetations and of mitral valve fenestration, and by the differentiation of mitral vegetation from prolapse or aneurysm), in the identification of source of embolism (by easier visualization of patent foramen ovale and of the left atrial appendage thrombus), in the imaging of ascending aorta, of right ventricular outflow tract and of the left ventricular endocardium. Biplane technique enhanced therapeutic decision making particularly in the indications of anticoagulant treatment and in planning certain cardiac operations. Biplane TEE is an easily acquired technique and it will replace single plane TEE in a number of indications.
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PMID:[Clinical use of biplane transesophageal echocardiography]. 157 40

During the period February to December 1990, 52 adult patients were referred to our clinic for evaluation of the presence of the Marfan syndrome. In 24 out of 52 patients the Marfan syndrome was diagnosed. Cardiac abnormalities were found in all patients: mitral insufficiency because of mitral valve prolapse (83%), aortic dilatation (67%), aortic insufficiency (38%), tricuspid valve insufficiency with or without tricuspid valve prolapse (17%) and atrial septal defect (4%). In 3 patients an aneurysm of the ascending aorta was found. Early recognition of the Marfan syndrome is relevant for prevention of the life threatening complication of aortic dissection. In patients with valve abnormalities endocarditis prophylaxis is advised. A Marfan outpatient clinic offers optimal diagnostic possibilities.
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PMID:[Cardiovascular abnormalities in Marfan syndrome]. 162 Feb 55

To detect potential cardiac abnormalities induced by intravenous heroin use, 68 persons without a previous episode of infective endocarditis were studied by Doppler echocardiography. A control group of 41 normal subjects was studied for comparison. The following measurements were considered: (1) diameter of heart chambers, (2) systolic left ventricular function, (3) morphologic valvular abnormalities, (4) presence of valve regurgitations, (5) Doppler indexes of diastolic function, and (6) estimation of pulmonary arterial resistances. Results showed no significant differences regarding the size of the heart chambers or systolic left ventricular function. A significantly higher incidence of valvular abnormalities (focal thickening or valve prolapse) was found in drug addicts (p = 0.0009) at the mitral and tricuspid valves, as was valvular regurgitation detected by Doppler (p = 0.04). Also, a significantly prolonged deceleration time of mitral and tricuspid early diastolic Doppler flow was found in the study group (p = 0.0001 and 0.027, respectively) although a different hemodynamic condition in the study group (pharmacologically reduced preload) precluded these findings to be attributable to an actual diastolic dysfunction. No differences were observed in pulmonary arterial resistances. It is concluded that mitral and tricuspid valve abnormalities can be detected by echocardiography in asymptomatic intravenous heroin users, whereas no apparent effects are observed in morphologic or functional parameters of cardiac structures other than the valves.
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PMID:Findings on Doppler echocardiography in asymptomatic intravenous heroin users. 173 65

Clinical characteristics of 60 (41 males, 19 females) patients with echocardiographically proven mitral valve prolapse were analysed, with special interest in the associated thoracic skeletal abnormalities. There was a male preponderance (2.2:1) and 91.7% of patients were symptomatic--atypical chest pain, palpitations, exertional dyspnoea and easy fatiguability being the major symptoms. Sixty seven percent had an asthenic body habitus, and 55% had high-arched palate. Thoracic scoliosis (55%), straight back syndrome (50%), flat chest (46.7%), and pectus excavatum (20%) were seen in association with the condition, with 81.7% having any one or combination of these features. Lateral chest radiography showed pancaking of heart shadow in 48.3%. Isolated non-ejection systolic click(s) was the major cardiac auscultatory finding (61.7%), while 60% showed pansystolic prolapse on echocardiography. Electrocardiographic ST-T-U changes in the inferior and/or lateral chest leads were seen in 46.7%, while 16.7% had cardiac arrhythmias. None had infective endocarditis, heart failure or cerebral embolic events. The findings corroborate the view that thoracic skeletal anomalies may be regarded as non-auscultatory features of this syndrome.
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PMID:Mitral valve prolapse syndrome and associated thoracic skeletal abnormalities. 130 Oct 49

Four patients with infective endocarditis caused by Actinobacillus actinomycetemcomitans seen at the National Taiwan University Hospital between January 1985 and December 1990 are reported. There were two men and two women with a mean age of 40 years. Three had had a xenograft replacement, the other one had prolapse of mitral valve. Carious teeth were noted in two. The most common presenting symptoms were fever, cough, dyspnoea, and weight loss and the duration of symptoms before diagnosis varied from 2 weeks to 2 months. Peripheral stigmata of endocarditis were not present in any patient. Laboratory investigation revealed haematuria and anaemia in three patients, and elevated erythrocyte sedimentation rates in all four. None had leucocytosis. Echocardiography was performed more than once for each patient and vegetation was demonstrated in only one. Blood culture became positive after 7-10 days of incubation. One of the isolates was resistant to penicillin. The diagnosis was delayed due to the indolent clinical course, non-specific presentation, and the slow growth of the organism. However, all patients were cured clinically and bacteriologically after 6 weeks of intravenous antibiotic therapy which included penicillin, cefamandole, chloramphenicol, or aztreonam, with or without an aminoglycoside. All patients were free of evidence of recurrence after 6-25 months of follow-up.
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PMID:Actinobacillus actinomycetemcomitans endocarditis: a report of four cases and review of the literature. 180 Oct 59

A rare case of ischemic stroke related to Herpes zoster infection of the eye and documented arteritis in an HIV-positive patient is analyzed. The woman, aged 32, who was born in Angola and lived in Zaire, was diagnoses at the Hospital Universitario de Santa Maria, Lisbon. She presented with a 5-month history of sudden hemiplegia, 4 months after onset of herpes zoster ophthalmicus. Among extensive diagnosis tests, she was positive for HIV by ELISA and Western blot, hepatomegaly, and generalized lymphadenopathy. She has left Herpes zoster ophthalmicus with ptosis bulbi and mottled discoloration of the skin over the distribution of the 1st division of the left trigeminal nerve, and right spastic hemiparesis. Her helper T-cell count was 952/cubic mm, and her T-cell ratio was 0.9. She had anemia, hypoalbuminemia, positive serology for cytomegalovirus, Herpes simplex, Epstein Barr virus, and hepatitis B. She had no bacterial infections, but her stool contained Trichuris trichiura eggs and giardia lamblia cysts. Her cardiovascular system and cerebrovascular fluid were negative. Computed tomography of the head showed an old left capsular infarct. Cerebral angiography showed arteritis of the left choroidal artery with occlusion. She was treated with metronidazole and mebendazole, and had surgery for removal of the left eye with a prosthetic replacement. Strokes are common in AIDS patients, resulting from fungal infections, endocarditis, infectious or non-infectious emboli, or arteritis from herpes zoster infections. This is the 1st published case of hemiplegia and Herpes zoster in a European or African patient with HIV-1.
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PMID:Herpes zoster and controlateral hemiplegia in an African patient infected with HIV-1. 186 23

From 1969 to 1985, mitral valve repairs using Carpentier's technique were performed for acquired mitral valve incompetence. 72 patients required a reoperation 3 days to 13 years later (mean 5 +/- 3.5 years). The reoperation rate risk was dependent upon the etiology: Barlow 0.6 +/- 0.2% patient year, fibro-elastic deficiency 0.7 +/- 0.3, endocarditis 1.7% Rheumatic disease 4.6 +/- 1.4%. The risk of reoperation in Rheumatic disease is significantly higher (p less than 0.05) than in degenerative disease. The causes of failures could be categorized into two groups according to whether they are surgeon related or valve related: Group I, Prosthetic ring dehiscence or malposition 15%, anulus dilatation (when no ring was implanted) 4%, triangular resection of the anterior leaflet 4% residual prolapse 8.3%. Group II, Recurrent prolapse 16.6% valve stenosis 17%, leaflet retraction 35%. Failures in Group I can be reduced with "increased" experience as opposed to group II. At reoperation valve repair was possible in 15.3% of the cases whereas valve replacement was necessary in 84.7% with an overall operative mortality of 1.4%. We conclude that mitral valve repair in acquired mitral incompetence carries out a small risk of reoperation. Most of the repair failures are surgeon related in degenerative disease and valve related in rheumatic disease.
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PMID:Failures in reconstructive mitral valve surgery. 194 82


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