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

Two patients underwent valve surgery using the minimally invasive approach. A 51-year-old man underwent mitral valve repair for chronic mitral regurgitation due to prolapse of the posterior mitral leaflet. The left-half of his sternum was cut in "C" shape below the level of the second intercostal space, and all of the arterial or venous cannulas were inserted via this single access. A 37-year-old man underwent aortic valve replacement for aortic valve regurgitation due to infective endocarditis. Right upper partial sternotomy between the first and fourth intercostal space was selected for this aortic valve surgery. The median skin incisions were as small as 12 and 9 cm. Postoperative recovery was very smooth. Minimally invasive approach using selected partial sternotomy provides acceptable results with a good exposure, and is an alternative approach to valve surgery.
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PMID:[Minimally invasive surgery for single valvular heart disease]. 1055 39

This study sought to test whether anomalous cardiac and aortic structures can be differentiated from native tissue and artifacts by physical properties of tissue motion using transesophageal tissue Doppler echocardiography (TDE). TDE was employed in 85 consecutive patients after anomalous structures had been detected by conventional transesophageal echocardiography (TEE). The control group consisted of 40 randomized patients. Certainty of diagnosis was divided into 4 categories, and TDE signals were related to particular anomalous structures by a blinded second observer. A mechanical model of a beating ventricle was constructed and suspended in a water bath. Synthetic material was utilized to simulate anomalous intracavitary structures with varying shape, consistency, and attachment. Incoherent motion was present in endocarditic vegetations, freely oscillating thrombi, fourth-degree aortic plaques, Chiari network, valvular prolapse, tumors, and in normal valve leaflets and papillary muscles. Within 15 seconds vegetations could be detected in 17 patients (68%) using TDE versus 5 patients (20%) using only conventional imaging. Coherent motion with a phase difference occurred due to damped oscillation. This phenomenon occurred in 5 patients with thrombi of the left atrial appendage (100%), in 3 ventricular clots (75%), and in 2 hypernephroma in the right atrium (100%). Rapid identification of clots could be achieved in 15 patients (71%) versus 12 patients (57%). Concordant motion was shown in third-degree aortic plaques, postrheumatic valvular lesions, and aortic intramural hematomas, but diagnostic benefit could not be demonstrated. In 41 patients (48%) histopathologic and intraoperative results confirmed echocardiographic findings. Motion patterns could be reproduced independently of the heart rate by model experiments. This study demonstrates that TDE expedites the detection of vegetations in infective endocarditis. Diagnostic certainty can be increased as well for thrombus formations.
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PMID:Usefulness of motion patterns indentified by tissue Doppler echocardiography for diagnosing various cardiac masses, particularly valvular vegetations. 1060 17

Mitral valve prolapse is a pathologic anatomic and physiologic abnormality of the mitral valve apparatus affecting mitral leaflet motion. "Mitral valve prolapse syndrome" is a term often used to describe a constellation of mitral valve prolapse and associated symptoms or other physical abnormalities such as autonomic dysfunction, palpitations and pectus excavatum. The importance of recognizing that mitral valve prolapse may occur as an isolated disorder or with other coincident findings has led to the use of both terms. Mitral valve prolapse syndrome, which occurs in 3 to 6 percent of Americans, is caused by a systolic billowing of one or both mitral leaflets into the left atrium, with or without mitral regurgitation. It is often discovered during routine cardiac auscultation or when echocardiography is performed for another reason. Most patients with mitral valve prolapse are asymptomatic. Those who have symptoms commonly report chest discomfort, anxiety, fatigue and dyspnea, but whether these are actually due to mitral valve prolapse is not certain. The principal physical finding is a midsystolic click, which frequently is followed by a late systolic murmur. Although echocardiography is the most useful mode for identifying mitral valve prolapse, it is not recommended as a screening tool for mitral valve prolapse in patients who have no systolic click or murmur on careful auscultation. Mitral valve prolapse has a benign prognosis and a complication rate of 2 percent per year. The progression of mitral regurgitation may cause dilation of the left-sided heart chambers. Infective endocarditis is a potential complication. Patients with mitral valve prolapse syndrome who have murmurs and/or thickened redundant leaflets seen on echocardiography should receive antibiotic prophylaxis against endocarditis.
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PMID:Current management of mitral valve prolapse. 1145 36

Mid-term results of mitral valve repair for mitral regurgitation were evaluated in 173 consecutive patients (mean age 53 years, 107 males, 66 females) treated from July 1991 to March 1998. Pathological causes of the mitral valve disease were degenerative in 118 patients, infective endocarditis in 25, rheumatic in 13, and ischemic in 8 (ischemic cardiomyopathy in 7). The principal technique was chordal replacement with expanded polytetrafluoroethylene sutures for prolapse of the anterior leaflet, and Carpentier's sliding leaflet technique for prolapse of the posterior leaflet. Most patients received ring annuloplasty with a rigid ring and flexible band (physiological remodeling annuloplasty). Intraoperative transesophageal echocardiography was used after 1993. There were 7 operative deaths (4%) and 7 mitral valve replacements (4%) during the same operation. Successful repair was achieved in 96% of patients with mitral regurgitation. Mean follow-up was 35 months (range 2 to 78 months). Survival at 6 years was 85 +/- 10% of all patients, 98 +/- 2% in degenerative cases. Six patients required reoperation (1.2%/patient-year) and mean time interval between initial operation and reoperation was 33.1 months. Four patients with atrial fibrillation had thromboembolic events (0.8%/patient-year). There were no anticoagulant-related complications. Freedom from reoperation and all valve-related event at 6 years was 88 +/- 6% and 84 +/- 6%. Late postoperative Doppler echocardiography revealed satisfactory results in 93% of the patients. Mitral valve repair using chordal replacement, sliding plasty and ring annuloplasty provides excellent mid-term results.
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PMID:[Surgical treatment for mitral regurgitation: mid-term outcome following mitral valve repair]. 1088 79

Ventricular septal defects (VSDs) are the most common congenital heart malformations seen in children. Because spontaneous closure occurs frequently, patients with small VSDs should be followed clinically with no limitations except endocarditis prophylaxis. Surgical closure is recommended for only small defects with significant associated lesions such as aortic regurgitation, aortic valve prolapse, right or left ventricular outflow obstruction, tricuspid regurgitation, left ventricle to right atrial shunt, or recurrent endocarditis. Enlarging left ventricular size or deteriorating left ventricular function would also be an indication for surgical repair. Moderate and large VSDs in infancy often require treatment of congestive heart failure with diuretics, digitalis, and afterload reduction. Surgical closure before 9 months of age is indicated for large VSDs and by 2 years of age for moderate shunts to prevent pulmonary vascular obstructive disease and the consequences of long-standing volume overload. Device closure of VSD is still in the investigational stage but holds promise for treatment of apical or multiple muscular VSDs.
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PMID:Ventricular Septal Defect. 1109 97

It is well recognized that the floppy mitral valve (FMV) complex is the central issue in the FMV, mitral valve prolapse (MVP), and mitral valvular regurgitation (MVR) story. MVP associated with the FMV results from the systolic movement of portions or segments of the FMV complex into the left atrium (LA). Prolapse of the FMV results in unique forms of mitral valvular dysfunction and MVR. When the FMV is recognized as the basic point of reference, diagnostic and nosologic characterizations are simplified. Each of the consequences of FMV dysfunction--MVP, MVR, and FMV surface phenomena--are dynamic entities and contribute to the symptoms and clinical course in this patient population. Although MVP may occur in the absence of a FMV in individuals with small left ventricular (LV) volume, hyperdynamic, or hypercontractile LV, we do not consider this phenomenon as part of FMV/MVP/MVR. The natural history of the FMV/MVP/MVR is long, and understanding the life history requires long-term follow-up with serial evaluations. Identification of those individuals with FMV/MVP whose symptoms are related to, or associated with, autonomic nervous system dysfunction (ie, the FMV/MVP syndrome) is important, as this distinction has diagnostic and therapeutic implications. In general, patients with FMV/MVP should receive antibiotic prophylaxis for infective endocarditis. Data suggest that therapy with angiotensin-converting enzyme inhibitors for FMV/MVP and significant MVR may slow the natural regression of the disease. Surgical therapy should be considered in patients with significant MVR and symptoms related to MVR. Explanation for the nature of these symptoms, reassurance, avoidance of volume depletion, catecholamines or other cycle-AMP stimulants and a regular exercise program constitute the basic principles of management for patients with FMV/MVP syndrome.
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PMID:Floppy Mitral Valve, Mitral Valve Prolapse, and Mitral Valvular Regurgitation. 1113 86

Mitral valvuloplasty can be applied in many situations and is quite effective in many cases. However, since it requires surgical skill based on knowledge and experience, there is a risk for recurrent surgery and reoperation was necessary in 5-8% of all cases in the first three years. 80-95% required no reoperation in ten years. Reoperation was performed mostly in cases of active endocarditis and extensive anterior leaflet prolapse. Reasons for reoperation were incomplete repair, tissue injury on sutured portion, recurrent annulus dilatation, reprolongation of chordae and hemolysis. To attain better surgical results in of mitral valvuloplasty the basic technique should consist of the resection and suture method and the fragile portion should be sutured with a patch. Careful attention should be paid to attaining a good coaptation of leaflet at the end of repair, sufficient remodeling of dilated annulus and to careful suturing of the prosthetic ring. It is also important to have an experienced operator perform transesophageal echocardiogram, and if more than 2 cm2 residual regurgitation is observed, immediate examination and treatment should be performed. In case of mitral regurgitation after surgery, careful assessment for reoperation can contribute to good late surgical results.
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PMID:Notes to avoid failure in mitral valvuloplasty. 1137 Dec 74

To what extent is prolapse of the mitral valve associated with mitral regurgitation and the risk of infective endocarditis, rupture of the chordae tendineae, and sudden death? Earlier studies used differing definitions and criteria, and reported prevalence of this deformity varied widely, especially between referral and general population studies. Advances in echocardiography have clarified the diagnosis, allowing classification of prolapse into subtypes associated with different degrees of risk and prognoses.
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PMID:Mitral valve prolapse: time for a fresh look. 1243 84

We report the case of a 50-year-old man in whom a supracristal ventricular septal defect led to aortic regurgitation and, thus, to consecutive sterile perforation of the anterior mitral leaflet, culminating in the development of severe systolic and diastolic mitral regurgitation. Aortic regurgitation as a result of valve prolapse caused by a supracristal (conal) ventricular septal defect is a well-known phenomenon. The same is true for the origin of mitral jet lesions in patients with infective endocarditis of the aortic valve. As of yet, there have been no reports about the acquisition of mitral valve perforations in patients without the history of vegetations. Moreover, the occurrence of diastolic mitral regurgitation is usually associated with atrioventricular pressure reversal, a phenomenon that was not present in our patient. The unique comorbidity was easy to detect with Doppler echocardiography, supported by transesophageal 2-dimensional and dynamic 3-dimensional echocardiography for preoperative surgical treatment.
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PMID:An unusual cause of diastolic mitral regurgitation as a result of sterile perforation of the mitral valve. 1251 40

Echocardiographic assessment of mitral regurgitation allows the diagnosis of its mechanism and cause which are major determinants in the feasibility of mitral valve repair. This assessment is based on a systematic analysis of the different structures of the mitral valve apparatus: mitral annulus (enlargement, calcification), mitral valve morphology (thickening, calcification, floppy valve, vegetations, perforation), mitral valve motion (restriction, identification of the prolapsed leaflets and scallops in patients with mitral valve prolapse or flail leaflets), subvalvular apparatus (ruptured chordae, thickening), papillary muscles, and left ventricular wall. This analysis can diagnose the mechanism of mitral regurgitation according to the Carpentier classification, and can clarify its cause: degenerative lesions (prolapse or flail leaflet with or without ruptured chordae), rheumatic lesions (thickened valves with restricted motion), endocarditis (vegetations, perforation, ruptured chordae), ischemic mitral regurgitation (restricted valve motion with inferior or posterior left ventricular wall asynergy), or functional mitral regurgitation (annular dilatation, displacement of papillary muscles with restricted leaflet motion). Transthoracic echocardiography with harmonic imaging usually allows a comprehensive assessment of functional anatomy of mitral regurgitation. Transesophageal echocardiography is indicated if transthoracic echocardiography is inadequate. It is also indicated just before surgery and as an intraoperative procedure. Real time 3D echocardiography should probably complete the evaluation of mitral regurgitation in the near future.
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PMID:[Use of echocardiography in mitral regurgitation for the assessment of its mechanism and etiology for the morphological analysis of the mitral valve]. 1275 63


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