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

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

Results of two-dimensional echocardiographic examinations were compared with angiographic, hemodynamic and surgical results in 44 patients with bioprosthetic valves in mitral and aortic positions who were undergoing elective or urgent reinvestigation 24 to 87 months (mean 34) after implantation. In these patients, there were 18 homograft aortic valves in the aortic position, 9 stent-mounted homograft aortic valves in the mitral position, 13 porcine xenograft valves in the mitral position and 12 in the aortic position. Poor cusp support, gross fluttering and prolapse of cusps behind or below the anulus identified aortic insufficiency by two-dimensional echocardiography in six patients with an aortic homograft and four patients were identified with insufficiency of a stent-mounted aortic homograft in the mitral position. Two-dimensional echocardiographic examination revealed mitral stenosis in three patients with a porcine xenograft valve in the mitral position and suggested mitral insufficiency in two others. Bacterial endocarditis on homograft or porcine xenograft valves was associated with easily imaged vegetations by two-dimensional echocardiography in 10 patients. Despite difficulties in imaging valve cusps, and the skill required to obtain good echocardiographic images of bioprosthetic valves, significant valve deterioration or infected prostheses were quite effectively imaged by two-dimensional echocardiography in this study.
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PMID:Detection of deterioration or infection of homograft and porcine xenograft bioprosthetic valves in mitral and aortic positions by two-dimensional echocardiographic examination. 687 8

The radiographic and pathologic features of 13 cases of mycotic aneurysm of the aorta were reviewed retrospectively. In four cases the mycotic aneurysm was associated with bacterial endocarditis following aortic valve replacement, and in nine cases it was associated with spontaneous bacterial endocarditis. Postmortem examination revealed that the mycotic aneurysm was most frequently found in cases with bicuspid aortic valves. In all cases the chest radiograph revealed cardiomegally, usually with pulmonary vascular congestion. In the six patients in whom the diagnosis was established angiographically, the aneurysm was manifested by an irregular saccular collection of contrast medium under one of the coronary arteries. Mycotic aneurysms must be differentiated from other lesions with similar angiographic findings, such as a congenital aneurysm of the sinus of Valsalva, prolapse of an aortic cusp through a membranous ventricular septal defect, and a congenital aortic-left ventricular tunnel.
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PMID:Mycotic aneurysm of the aorta. 689 95

A 25-year-old quadriplegic man with mitral leaflet prolapse syndrome was seen for complaints of intermittent fever, chills, and cough of three months' duration. Subacute bacterial endocarditis was diagnosed. Unusual complications of this disorder included hyperplenism with pancytopenia, pericardial effusion, and multiple infections in the blood and the spleen. Antibiotic therapy was begun, and splenectomy was performed. After seven weeks of treatment, the patient was free of symptoms and was discharged with advice on appropriate antibiotic prophylaxis. We believe that although bacterial endocarditis is a major complication of mitral leaflet prolapse syndrome, it can be prevented with antibiotic prophylaxis whenever dental, surgical, or other invasive procedures are performed.
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PMID:Bacterial endocarditis in mitral leaflet prolapse syndrome. 707 Oct 31

All patients 20 years old or older referred for echocardiographic examination and found to have mitral valve prolapse during the period January 1975 through December 1979 were included in the study. Of the 1,138 patients, two-thirds were women and one-third were men. Their average age was 48.4 years. Forty patients (3.5%) had histories of prior focal cerebrovascular ischemic events. In 26 of the 40 patients, no responsible mechanism other than mitra valve prolapse was identified, and in 4, the ischemic event occurred during an episode of bacterial endocarditis, a known complication of mitral valve prolapse. In 10 of the 26 patients, there was clinical information to suggest an embolic mechanism for the ischemic. A conservative estimate of the prevalence rate for cerebral infarction in this group of patients is four times greater than the rate expected in a normal population. This difference is likely due to the contribution of mitral valve prolapse in the pathogenesis of cerebral infarction.
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PMID:Cerebral ischemic events in patients with mitral valve prolapse. 710 43

The absence of controlled evidence and the high prevalence of mitral-valve prolapse have created substantial uncertainty about whether this condition is an important risk factor for bacterial endocarditis. We evaluated this risk in a case-control study of hospital inpatients who had undergone echocardiography and who lacked any known cardiovascular risk factors for endocarditis, apart from mitral-valve prolapse and isolated mitral-regurgitant murmurs. Thirteen (25 per cent) of 51 patients with endocarditis had mitral-valve prolapse, as compared with 10 (seven per cent) of the 153 matched controls without endocarditis. For the 51 matched case-control sets, the odds ratio (8.2; 95 per cent confidence interval, 2.4 to 28.4) indicated a substantially higher risk of endocarditis for people with mitral-valve prolapse than for those without it. This association remained statistically significant when parenteral drug abuse and routine antibiotic prophylaxis preceding dental work and other forms of instrumentation were taken into account. Furthermore, the risk may be higher than is indicated by this study, since 46 per cent of the controls underwent echocardiography for clinically suspected mitral-valve prolapse, suggesting an overrepresentation of mitral prolapse in the control group. The results support the contention that mitral-valve prolapse is a significant risk factor for bacterial endocarditis.
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PMID:A controlled evaluation of the risk of bacterial endocarditis in persons with mitral-valve prolapse. 711 Feb 42

Clinical survey was made on the porcine xenograft valve replacements in 76 patients who underwent the replacement for the past five years at Hyogo College of Medicine Hospital. The follow-up period was from 3 to 84 months after implantation. Seventy-one patients had mitral valve replacements, 1 aortic, 2 mitral and tricuspid and 2 tricuspid. Seven patients were diagnosed as porcine valve dysfunction echocardiographically, and in four of these the dysfunction (two with bacterial endocarditis, one with perivalvular leak and one with ruptured porcine aortic valve) was confirmed at operation, and the echocardiographic features were correlated with surgical findings. M-mode and two-dimensional echocardiograms of one patient with fungal endocarditis demonstrated vegetations on the mitral and tricuspid valves. In another patient with endocarditis, the echocardiographic finding of valve thickening associated with the flail and torn cusp was observed. The two-dimensional echocardiographic study was particularly useful in detecting the dislocation of the stent echo in one patient with paravalvular regurgitation. In one patient with the ruptured and flail porcine aortic valve, the two-dimensional echocardiogram was characterized by rapid diastolic motion of the involved leaflet into the left ventricular outflow tract beyond the line of valve closure. Three patients were not confirmed at operation. In one patient, the two-dimensional echocardiogram demonstrated a systolic prolapse of the porcine mitral valve. In another two patients the M-mode echocardiographic finding included a coarse fluttering of the porcine mitral cusp in diastole. The major M-mode features of prosthetic regurgitation were fuzzy echoes with fluttering of the cusp in systole or diastole or both. In one patient with fluttering, the two-dimensional echocardiogram also demonstrated the thickening of the cusp. But in another patient with fluttering, the two-dimensional echocardiogram revealed no abnormality, and prosthetic regurgitation was not confirmed at cardiac catheterization. It was postulated that this patient had a false positive echocardiogram. Two-dimensional echocardiography complemented the M-mode echocardiographic findings and both techniques were very useful in identifying porcine valve dysfunction. Moreover, we considered that the comparison of the echocardiographic features in the course of individual case was very important in detecting porcine valve dysfunction.
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PMID:[M-mode and two-dimensional echocardiographic features of porcine xenograft valve dysfunction]. 711 97

In a 32-year-old woman with mitral prolapse, bacterial endocarditis was preceded by a long period of neuralgias and skin lesions. Thrombosis of the Sylvian artery heralded the onset of the disease which remained for a long time apyretic and was marked by several cerebral vascular accidents. After failure of antibiotic therapy the mitral valve was replaced by a Starr valve and the patient recovered. In view of the presence of immunological abnormalities in this patient, the mechanisms of the vascular lesions is discussed. Many authors are new giving a large place to "immunoallergic" theories in their attempts to explain the occurrence of non-specific arteritis in bacterial endocarditis.
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PMID:[Bacterial endocarditis on mitral prolapse revealed by cutaneous and neurological disorders. Usefulness of immunological investigations (author's transl)]. 729 Sep 41

Computerized information systems, especially decision support systems, have become an increasingly important role in medical applications, particularly in those where important decision must be made effectively and reliably. But the possibility of using computers in medical decision making is limited by many difficulties, including the complexity of conventional computer languages, methodologies and tools. Thus a conceptual simple decision making model with the possibility of automating learning should be used. In this paper we introduce a cardiological knowledge-based system based on the decision tree approach supporting the mitral valve prolapse determination. Prolapse is defined as the displacement of a bodily part from its normal position. The term mitral valve prolaps (PMV), therefore, implies that the mitral leaflets are displaced relative to some structure, generally taken to the mitral annulus. The implications of the PMV are the following: disturbed normal laminar blood flow, turbulence of the blood flow, injury of the chordae tendinae, the possibility of thrombus's composition, bacterial endocarditis, and finally hemodynamic changes defined as mitral insufficiency and mitral regurgitation. Uncertainty persists about how it should be diagnosed and about its clinical importance. It is our deep belief that the echocardiography enables properly trained experts armed with proper criteria to evaluate PMV almost 100%. But unfortunately, there are some problems concerned with the use of echocardiography. In that manner we have decided to start a research project aimed at finding new criteria and enabling the general practitioner to evaluate PMV using conventional methods and to select potential patients from the general population.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Decision trees based on automatic learning and their use in cardiology. 782 81

Between September 1980 and August 1988, 21 patients, of mean age 7.3 (range 1-19) years, with ventricular septal defect and aortic valve prolapse, underwent surgery. Aortic insufficiency was mild in three patients, moderate in 13 and severe in five. Surgical repair was performed using a combined transaortic and transpulmonary approach. The prolapsed leaflets were evaluated through the ventricular septal defect before and after valvuloplasty. Using the Trusler technique, the prolapsed cusps were plicated at the level of the commissures; only one patient required aortic valve replacement. After functional assessment of the valve repair, through the ventricular septal defect, during infusion of cardioplegia in the aortic root, the defects were closed through the pulmonary artery, or through a right atriotomy. Mean follow-up was 51.5 (range 3-108) months. One patient developed bacterial endocarditis and died 3 months after surgery. The other 20 patients remained symptom-free. There are no residual ventricular septal defects, and mild residual aortic insufficiency is present in six patients. The mean(s.d.) cardiothoracic ratio decreased from 0.61(0.07) before to 0.49(0.05) after surgery. In summary, preservation and repair of the prolapsed aortic valve is possible even in the presence of severe aortic insufficiency. The combined approach through both great arteries enables good visualization with minimal traction, and accurate assessment of the aortic valvuloplasty through the ventricular septal defect. In addition, problems associated with a right ventriculotomy are avoided.
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PMID:Combined transaortic-transpulmonary approach for surgical repair of aortic insufficiency associated with ventricular septal defect. 807 11


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