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

Current knowledge concerning idiopathic prolapse of the mitral valve is illustrated. The histopathological cause is myxoid degeneration of the mitral cusps, which sometimes extends to the tendinous cords, the valve implant ring, and the apex of the papillary muscles. Primary damage to these structures, whose intactness is essential for correct closure of the ostium, causes protrusion of the ventricular cusps into the left atrium during ventricular systole (i.e. prolapse). The reason for this degeneration is not known. The high familial incidence of prolapse lends credit to the most widely held suggestion, namely a hereditary defect. The clinical progress is benign in the great majority of cases ("crystallized" form) and is often asymptomatic. Complications are possible, however, and must always be borne in mind. They include progressive and acute mitral insufficiency, infective endocarditis, arrhythmias, motor or sensitive neurological complications, and sudden death. Particular attention must be paid to the path to be followed to arrive at the correct diagnosis. Careful evaluation of some of the clinical signs arousing suspicion in the previous history and/or objective examination enable a diagnosis to be formed with relatively simple, non-invasive instrumental techniques, such as echocardiography and polycardiography, provided other forms of prolapse secondary to ischaemic heart disease, mitral endocarditis, etc. are excluded. "Therapy is obviously necessary in the presence of complications; however, even in "crystallized" form, in the presence of subjective symptoms, tranquillizers and possibly beta-blockers may be necessary".
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PMID:[Idiopathic mitral valve prolapse]. 613 73

Valve replacement was performed during a 7-year period in 27 patients with acute or subacute infective endocarditis. Twenty-three patients had single valve affection--16 aortic and 7 mitral--and 4 patients had affection of both the aortic and mitral valves. Eight of the patients with aortic valve lesion had congenital aortic valve stenosis and 2 of the mitral patients had mitral prolapse. Two patients were operated upon only on the echocardiographic finding of valvular vegetations. The rest of the patients were operated because of cardiac insufficiency, intractable infection or peripheral embolization. Five patients died and 22 patients (82%) were discharged. One of these patients died in the follow-up period. The remaining 21 patients all belong to class I or II (NYHA) postoperatively. There were no cases of reinfection. Emphasis is placed on the use of echocardiography in detecting valvular vegetations, and the need to take the proper surgical action as a result of this finding, even in asymptomatic patients.
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PMID:Surgical treatment of bacterial endocarditis. 618 93

Small diameter aortic valve bioprostheses are associated with resting ventriculo-aortic pressure gradients of 10 to 35 mmHg. In order to avoid this factor favouring degradation of left ventricular function and early deterioration of the bioprosthesis, we enlarged the aortic ring when the diameter was less than 23 mm in patients considered unsuitable for long-term anticoagulation. The surgical technique involved incising the annulus from the postero-lateral commissure to the anterior mitral leaflet and implanting a Dacron patch lined with pericardium. Nine patients aged from 10 to 70 years (average 22 years) underwent aortic valve replacement with a Carpentier-Edwards bioprosthesis associated with enlargement of the aortic ring, between June 1979 and December 1981. The mean follow-up period is now 18 months (range 9 to 39 months). One patient has been lost to follow-up. Before surgery, 6 patients were in Stage III and 3 patients in Stage IV of the NYHA classification. There were 4 patients with pure aortic regurgitation with valve prolapse, 1 patient with aortic regurgitation due to endocarditis, and 4 patients with mixed aortic valve disease. The underlying disease was rheumatic in 6 cases, congenital in 2 cases and infective endocarditis in 1 case. The mean diameter of the aortic ring before enlargement was 19 mm. After the procedure, it increased to 23,8 mm, so enabling the implantation of no 23 and no 25 bioprostheses. Three patients had associated mitral regurgitation, 3 patients had mixed mitral valve disease, 1 patient had a membranous VSD with infundibular stenosis, and 1 patient had subvalvular aortic stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Aortic valve replacement by bioprosthesis with enlargement of the aortic ring]. 642 18

A 53 year old man died of cerebral hemorrhage while being treated for Streptococcus mutans endocarditis. At autopsy the only endocarditic lesion was on the left atrial mural endocardium. The noninfected mitral valve demonstrated prolapse and mucinous degeneration. The latter had led to rupture of several chordae tendineae, with the resultant jet stream predisposing to endocarditis at its point of atrial impact. The case provides confirmation of current concepts of the pathogenesis of endocarditis and has important therapeutic implications.
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PMID:Mitral valve prolapse: jet stream causing mural endocarditis. 644 92

To assess the reliability of M-mode echocardiographic patterns of mitral valve prolapse (MVP) (echo MVP) in detection of morphologic evidence of MVP (morphologic MVP), operatively excised mitral valves and corresponding M-mode echocardiograms from 65 patients with chronic, severe, isolated, pure mitral regurgitation (MR) were studied. Of the 65 patients, 45 (69%) had echo MVP (either holosystolic or mid-to-late systolic prolapse patterns on preoperative M-mode echograms) and 42 (93%) of them had morphologic MVP; of the 3 without morphologic MVP, 2 had ruptured chordae tendineae from infective endocarditis and 1 had papillary muscle dysfunction from atherosclerotic coronary heart disease. Of the 20 patients without echo MVP, 14 (70%) had no morphologic MVP (9 had papillary muscle dysfunction from coronary heart disease, 4 had infective endocarditis on previous normal valves and 1 had rheumatic heart disease). Of the 48 patients with morphologic MVP, 42 (88%) had echo MVP and most had considerably dilated mitral anulae; the other 6 had ruptured chordae tendineae with less degrees of anular dilatation. Of the 17 patients without morphologic MVP, 3 had echo MVP (coronary artery disease in 1 and infective endocarditis on a previous normal valve in 2); of the 14 with neither echo nor morphologic MVP, 9 had papillary muscle dysfunction from coronary artery disease, 4 had infective endocarditis on previously normal valves and 1 had rheumatic heart disease. The patients with very dilated mitral anuli and leaflet areas generally had holosystolic (hammocking) patterns on echo; the patients with small anuli and leaflet areas usually had mid-to-late systolic (buckling) prolapse patterns.
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PMID:Frequency and significance of M-mode echocardiographic evidence of mitral valve prolapse in clinically isolated pure mitral regurgitation: analysis of 65 patients having mitral valve replacement. 669 Dec 50

Because antibiotic prophylaxis for dental procedures in patients with mitral-valve prolapse (MVP) has been controversial, we performed a decision analysis to assess the costs and effects of the oral and parenteral penicillin regimens currently recommended for patients at high risk for bacterial endocarditis. The analysis suggests that there is a very small risk of post-dental endocarditis in MVP (4.1 cases per 10(6) procedures) which is outweighed by a greater risk of fatal reactions to parenteral penicillin (15 deaths per 10(6) courses). Parenteral penicillin prophylaxis therefore causes a net loss of life. For oral penicillin the risk of a fatal reaction is lower (0.9 deaths per 10(6) courses). However, oral penicillin prophylaxis appears to spare life only in older adults with MVP and at an extremely high cost: Over +1 million must be spent to spare one year of life. Personal preferences may still make antibiotic prophylaxis desirable for individual MVP patients. However, from a societal perspective, routine predental antibiotic prophylaxis for MVP is a very expensive preventive strategy.
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PMID:A quantitative assessment of pre-dental antibiotic prophylaxis for patients with mitral-valve prolapse. 674 44

The results of surgery on five patients aged between 4 and 14 years old with ventricular septal defect (VSD) and aortic incompetence (AI) are reported. Four of the five patients had massive AI, the diastolic blood pressure being 0 in 3 cases. All patients underwent catheterisation and angiography. In 1 case, an aneurysm of the sinus of Valsalva bulging into the infundibulum was detected. At operation, 3 infra-cristal, 1 supra cristal and 1 unclassified VSD were observed. Prolapse of the aortic cusps was present in three cases, and in two cases these lesions were complicated by infective endocarditis. Three patients were managed by a slightly modified version of Trusler's aortic valvuloplasty, and the two patients with endocarditis underwent aortic valve replacement. The VSD was closed by Dacron patch in 3 cases and directly in 2 cases. The immediate postoperative period was complicated in one case by haemorrage due to anticoagulant therapy causing tamponade and paraplegia. In the other four cases, there were no complications. The results of valvuloplasty were good with complete regression of the diastolic murmur. The medium-term results were good, with a maximum follow-up period of 21 months. One of the patients with an aortic valve prosthesis has minimal AI, probably due to a paravalvular leak. A number of points are discussed with respect to this small series of patients: anatomy, techniques, indications. The modified Trusler's valvuloplasty is recommended, even in cases of severe AI.
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PMID:[Surgical treatment of interventricular communication with aortic insufficiency. Apropos of 5 cases]. 677 28

The presence of a mass in the left ventricular outflow tract is often a sign of severe pathology. The authors report 4 cases illustrating this echocardiographic diagnosis. In bacterial or mycotic endocarditis these masses suggest either aortic valve vegetations or prolapse of an aortic cusp. Two causes may be observed in patients with aortic bioprostheses: paravalvular leak with rocking of the sewing ring and destruction of the bioprosthetic cusps. In the 4 cases presented hemodynamic and angiographic investigations were contra indicated because of the risk of embolism of bacterial vegetations. Echocardiography gave precise diagnosis of the causal disease process and led to early surgical cure. Correlations between the anatomical and echocardiographic appearances are described and discussed.
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PMID:[Monodimensional echographic study of echogenic masses in the left ventricular outflow tract in aortic valve insufficiencies. Apropos 5 cases]. 680 43

A horse, a cow, and a dog with aortic valve vegetative endocarditis were studied by M-mode echocardiography. Echocardiographic abnormalities of the aortic valve, mitral valve, and left ventricle were observed. These features were identical to those reported in human beings with aortic valve endocarditis. Abnormalities associated with aortic valve endocarditis included irregular thickening of the valve, multiple linear echoes in the aortic root, diastolic prolapse of the aortic vegetation, and diastolic fluttering of a torn aortic valve. Some of these features were found in each animal. The consequences of aortic regurgitation observed by echocardiography were left ventricular dilation, diastolic fluttering of the mitral valve, premature closure of the mitral valve, and left ventricular hyperkinesia.
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PMID:Echocardiographic features of aortic valve endocarditis in a dog, a cow, and a horse. 683 2

Two-dimensional echocardiography of Hancock porcine heterograft valves was evaluated by correlation with clinical, hemodynamic, angiographic and pathologic findings in 80 patients. Ninety-five aortic and mitral bioprostheses were categorized by the type of valvular abnormality: group I, dysfunction due to primary tissue failure (41 valves); group II, dysfunction due to paravalvular leakage without infection (5 valves); group III, infective endocarditis with or without hemodynamic dysfunction (28 valves); and group IV, control cases without dysfunction or infection (21 valves). Increased size of a bioprosthetic leaflet image (minimal dimensions 3 x 5 mm) was observed in 46% (19 of 41) of cases with primary tissue failure and in 62% (10 of 16) of cases with leaflet vegetations due to endocarditis. Prolapse of leaflet echoes to below the level of the bioprosthetic sewing ring occurred in 76% (28 of 37) of cases with torn leaflets and also in 46% (6 of 13) of valves with vegetations on intact leaflets. Antegrade extension of leaflet echoes to beyond the level of the stents, observed in 4 of 16 cases with leaflet vegetations, was the only echocardiographic sign distinguishing leaflet infection from leaflet degeneration. Aortic bioprostheses with ring dehiscence affecting 40 to 90% of the anular circumference showed motion discordant with the motion of the adjacent aortic root and native anulus. Although echocardiographic abnormalities are frequently observed with bioprosthetic leaflet degeneration or infection, the echocardiographic appearance often does not distinguish between these two major complications and is best interpreted concurrently with other clinical and laboratory assessment.
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PMID:Two-dimensional echocardiographic assessment of bioprosthetic valve dysfunction and infective endocarditis. 688 26


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