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

Between March, 1969 and March, 1984, 89 children aged from 2 to 12 years (mean: 8.3 +/- 2.5 years) and presenting with mitral valve regurgitation underwent valvuloplasty by the Carpentier technique. The cause of the regurgitation was rheumatic fever in 84 cases (94 p. 100), bacterial endocarditis in 4 cases and Barlow's disease in 1 case. Mitral valve regurgitation was divided into 3 types, namely: type I, normal valve motion (5 cases), type II, valve prolapse (74 cases) and type III, restricted valve motion due to fibrosis of the leaflets or chordae (20 cases). The hospital mortality rate was 2.3 p. 100 (2 deaths). The cumulative follow-up was 546 patients/years, and the actuarial survival rate at 10 years was 89.96 +/- 8.5 p. 100. At 10 years the actuarial thromboembolic complication rate was 2 p. 100, or 0.3 +/- 0.2 p. 100 per patient year, and the actuarial valvuloplasty deterioration rate was 27 +/- 8.5 p. 100. The risk of re-operation was 2.2 +/- 0.6 p. 100 per patient year. At 10 years 78.4 +/- 7.2 p. 100 of the children were free of all re-operation, and 69 p. 100 had no complication. Thus, whenever possible (i.e. in 90 p. 100 of the cases, according to our experience) and considering the satisfactory long-term results, all children with acquired mitral valve regurgitation should undergo mitral valvuloplasty as first-line treatment.
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PMID:[Valvuloplasties for acquired mitral insufficiency in children (Carpentier's technic). Long-term results in 87 cases]. 312 87

Mitral valve prolapse is an increasingly common etiology among patients presenting for mitral valve surgery. From 1985 through 1987, a total of 457 patients underwent surgery for pure mitral regurgitation. Of these, 304 (67%) had underlying mitral prolapse, 57 (12%) had rheumatic valvulitis, 36 (8%) had underlying ischemic disease, and 22 (5%) had bacterial endocarditis. The anatomic disturbance in the patients with prolapse was chordal rupture in 189 (62%), chordal elongation in 69 (23%), and isolated annular dilatation in 46 (15%). Valvuloplasty techniques were used in 294 patients (64%) overall. Among those with mitral prolapse, 208 patients (68%) underwent reconstructive procedures. Operative mortality for the entire group was 7% and for the valvuloplasty group it was 4%. We conclude that 1. in our patient population mitral prolapse is the most frequent etiology among patients requiring surgery for mitral regurgitation; 2. valvuloplasty techniques are applicable in the majority of these patients; 3. valvuloplasty can be performed with low operative mortality. Over the long term, available results indicate good clinical status and low rates of reoperation and thromboembolic events for patients who have undergone mitral valvuloplasty.
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PMID:Surgery for mitral prolapse. 320 74

In spite of two decades of research, the precise relationship of anatomic mitral valve prolapse (floppy valve) to the neuroendocrine disorder (MVP syndrome) remains unclear. In all likelihood they are two separate genetic disorders which travel together in some fashion. Mitral valve prolapse is a common disorder but progressive mitral regurgitation usually occurs late in life and in only a few patients. Other complications such as bacterial endocarditis, stroke, and sudden death are far less common but can occur at younger ages. The neuroendocrine syndrome in civilian life is mainly seen in young females (interestingly the peak incidence years correspond to peak female sex hormone output) but can be seen in males when subjected to unusual stress such as military service. More recent echocardiographic studies have questioned whether all prolapsing valves are truly abnormal. It has been shown that echographic prolapse can be produced in normal subjects by reducing venous return and impaired venous return may be present in some patients with the MVP syndrome. However, clicks and murmurs are apparently not heard when normal valves prolapse. It is our opinion that the presence of a click or typical murmur requires some anatomic abnormality of the mitral valve. One wonders if minimal valve abnormality (noted and dismissed by Davies) is the valve abnormality present in many young females with MVP syndrome, and that it may remain a mild abnormality throughout life. Recent psychiatric studies suggest that MVP is present in 30% of patients with Panic Disorder. It is not clear that this psychiatric syndrome is the same thing as the MVP syndrome. In Devereux's study, anxiety proneness was no different in the MVP cohort than in relatives without MVP. It is possible that diagnostic mixing of two similar but separate disorders has occurred, as has been the case since World War I. Perhaps the most important question is whether young patients with MVP syndrome and no echocardiographic criteria for "floppiness" will develop progressive mitral regurgitation or other complications in later life. In other words, how often is MVP syndrome in a young individual without echocardiographic evidence of a floppy valve a precourser to eventual progressive mitral regurgitation? Are there two different populations? Because of the long course of the disorder, several more years of observation (and, it is hoped, prospective longitudinal study) will be required to answer this question.
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PMID:The mitral valve prolapse epidemic: fact or fiction. 330 18

Mitral valve prolapse (MVP) is due to a heterogeneous group of conditions that may affect the mitral valve or the mitral valve apparatus. Although MVP may progress later in life to frank mitral insufficiency requiring mitral valve repair or may predispose to bacterial endocarditis, in most cases it is a benign, idiopathic condition without serious consequences. However, many investigators have documented that MVP is often associated with a constellation of signs and symptoms, which appear to constitute a distinct syndrome. These associated findings include autonomic dysfunction, frequent complaints of chest pain, palpitations, orthostasis, fatigue, dyspnea on exertion and anxiety. Although the risk of significant myocardial dysfunction or bacterial endocarditis appears to be related to patient sex, age and the severity of valvular prolapse and insufficiency, there appears to be little or no relations between the extent of prolapse and the degree of autonomic dysfunction or the severity of symptoms of chest pain, palpitations, dyspnea on exertion and anxiety. The development of uniform diagnostic standards for mental disorders has helped to make it possible to identify several related entities, including generalized anxiety disorder, panic disorder and agoraphobia; patients with these disorders frequently somatize their anxiety and complain of many symptoms which may be seen in patients with MVP. Although several studies have reported an increased frequency of MVP in patients with anxiety disorders, recent studies suggest that the conditions are not linked. Iatrogenic cardiac neurosis is common in both groups of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Mitral valve prolapse: from syndrome to disease. 332 70

In a retrospective ultrasonographic study, 32 cases of acquired disease of the tricuspid valve were detected amongst 7000 consecutive patients. Patients with congenital heart disease (except when the seat of an acquired disease) and with prosthetic heart valves, were excluded. There were twenty-one cases of rheumatic disease, all having additional involvement of the mitral valve. Prolapse (5 patients), bacterial endocarditis (2 patients), rupture of papillary muscle (1 patient), cardiac tumours (2 patients) and carcinoid heart disease (1 patient) were also identified. Acquired disease of the tricuspid valve is infrequently encountered during routine cross-sectional echocardiography but its recognition is clinically important.
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PMID:Acquired abnormalities of the tricuspid valve--an ultrasonographic study. 354 79

MVP is a common condition with rare life-threatening implications. Recent follow-up studies over several years in children, and young and middle-aged adults failed to suggest increase in prolapse in most of the subjects. Older individuals with MVP appear to have increased complications, primarily due to mitral regurgitation. Echocardiography supports the diagnosis of MVP made by auscultation in over 90% of individuals, with excellent reproducibility. MVP is more common in young women than young men. The prevalence of prolapse decreases with age in women; it is relatively constant in men. Although complications are rare, MVP is the most common underlying disorder in rupture of the chordae tendineae. These spontaneous ruptures are usually unassociated with infective endocarditis. Familial studies indicate that isolated MVP is an autosomal dominant condition with variable expression. It is recommended that first-degree relatives of patients with isolated prolapse be examined. Infective endocarditis is uncommon, but it is recommended that antibiotic prophylaxis be implemented in patients with prolapse and evidence for mitral regurgitation. Prolapse is frequently associated with autonomic imbalance, primarily an increased catecholamine sensitivity. The use of beta blockers may reverse symptoms secondary to this abnormality. Sudden death is exceedingly rare despite marked arrhythmias in many patients. On the basis of retrospective studies, sudden death is associated with floppy valves, marked mitral regurgitation, and arrhythmias. There is no evidence that any class of antiarrhythmic agents can prevent the rare sudden deaths in these patients.
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PMID:Mitral valve prolapse: recent advances in diagnosis and therapy. 372 Feb 68

In this study, 100 consecutive, surgically excised, mitral valves were examined pathologically. The valves were classified according to primary conditions that resulted in valvular malfunction. Rheumatic mitral valvular diseases (stenosis and/or insufficiency) accounted for 54% of the cases. Myxomatous changes (prolapse) were present in 32 cases. Fifty-nine percent (19 cases) of those cases with myxomatous changes also had chordal rupture. Four of the cases had papillary muscle rupture, and in seven cases, papillary muscle dysfunction occurred. In one case bacterial endocarditis was observed on a previously normal valve. In one case the pathology of valvular. In one case the pathology of valvular changes was indeterminant. Lupus erythematosus was diagnosed in one patient, and mitral valve insufficiency may have resulted as a complication.
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PMID:Pathology of surgically excised mitral valves. One hundred consecutive cases. 383 54

In 125 consecutive patients, aged greater than or equal to 10 years (mean 27, range 10-64), evaluated for isolated ventricular septal defects (VSD) the initial prevalence of aortic regurgitation (AR) was 12/125. Forty-one patients were operated on, and post-operative mortality was 3/6 in patients operated on for VSD and AR and 1/35 in those operated on for VSD alone. All but one of the patients have been followed until death or beyond the age of 30 years (mean 42, range 31-73) and a prospective restudy has been performed after a mean observation time of 15 years (range 4-21). The incidence of new cases of AR arising during this period was 10/111. AR was severe in 5 cases (one died from heart failure), moderate in 1 and mild in 4. Surgical repair of AR and VSD was performed in 3 cases. Common characteristics of patients who developed AR were advanced age, male sex, history of bacterial endocarditis, small subaortic VSDs and tricuspid aortic valves without prolapse. Echocardiography revealed larger aortic root diameter (p less than 0.001), increased eccentricity factor (p less than 0.001) and increased left ventricular dimensions (p less than 0.02) in those with complicating AR. AR in adults with VSD may have an unpredictable clinical course; it may be difficult to assess clinically and the need for close clinical control is emphasized. Echocardiography remains of considerable value in selected cases.
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PMID:Aortic regurgitation associated with ventricular septal defects in adults. Clinical course, haemodynamic, angiographic and echocardiographic findings. 405 May 54

One hundred and eighty-two patients (100 females, 82 males) with mitral valve prolapse (MVP) confirmed by echocardiography are described. Their ages range from 12 to 87 years (mean 48 years). The symptoms of breathlessness, pain in the chest and palpitations were analysed. They were associated with left ventricular failure, co-existing ischaemic heart disease and arrhythmias in some, but in a proportion the symptoms were thought to be due to psychoneurosis. Seventy-two patients (40 per cent) were referred because of complications of MVP. In 67 patients (37 per cent) the condition was discovered by chance and in 43 patients (24 per cent) neurotic symptoms had led to referral to hospital. A systolic click was heard in 117 patients (54 per cent); 41 patients (23 per cent) had a late systolic murmur and 30 patients (16 per cent) had a pansystolic murmur. The incidence of murmurs rose with increasing age, and pansystolic murmurs were more frequent in males. Thirty-two patients (18 per cent) had neither a click nor a murmur. Twenty-four patients (13 per cent) had associated supraventricular tachycardia and 22 (12 per cent) atrial fibrillation. Twelve patients (7 per cent) had severe mitral incompetence and eight (4 per cent) developed bacterial endocarditis. Only three patients had symptoms suggesting cerebral ischaemia. Twelve patients (7 per cent) had associated aortic incompetence. Twenty-two patients had had an inguinal hernia, the incidence in males over 50 being 26 per cent. Twenty-six patients (14 per cent) had non-specific T wave changes in the electrocardiogram. Echocardiography showed that 112 patients (62 per cent) had mid-systolic buckling of the posterior leaflet and 70 patients (38 per cent) had holosystolic prolapse. In view of the high incidence of complications it is felt that the long-term prognosis not as good as has been generally believed.
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PMID:Mitral valve prolapse: an assessment of clinical features, associated conditions and prognosis. 661 38

Various pathological changes of the mitral valve (MV) apparatus have been reported to be associated with ruptured chordae tendineae (RCT). We studied the clinical importance of echocardiographic examination to detect the etiology of RCT in 15 cases with patho-anatomical findings obtained. The commonly observed echocardiographic abnormalities were diastolic MV flutter (80%), systolic MV vibration (73%), flicky (or exaggerated) MV motion (73%), MV prolapse (47%), and abnormal systolic echoes in the left atrium (53%). Diastolic flicky motion of the MV was observed exclusively in the patients of bacterial endocarditis accompanied with MV vegetations. The main ruptured chordae of the MV were recognized as floating chordal echoes. MV prolapse was associated with myxomatous changes of the valve or multiple echoes chordae tendineae. These results show that M-mode and two-dimensional echocardiography may be predictive to evaluate the etiology of RCT.
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PMID:[Echocardiographic recognition of ruptured chordae tendineae: patho-anatomical evaluation of the diagnostic criteria]. 667 72


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