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Query: UMLS:C0033377 (prolapse)
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Since Sir Gilbert Blane's report of a case in the year 1800, bilateral aneurysms of the internal carotid artery within the cavernous sinus of nontraumatic origin are extremely rare. In reviewing literatures, only 22 cases have been described, including the present case (Table 1). We are reporting our own case in which carotid angiograms revealed the presence of bilateral giant aneurysms with a carotid-cavernous fistula on one side, and discussed briefly with reference to its clinical features, radiological observations and treatment. (case report) M.R, a woman aged 78, was admitted on May 15, 1973, with a complaint of sudden onset of right supra- and periorbital headache and a loud bruit about 2 months previously. She became aware of ptosis of the right eyelid and prominence of the right eyeball. The carotid arteriogram showed bilateral giant aneurysms in the region of the cavernous sinus (Fig 2, Fig. 3). A carotid cavernous fistula due to the ruptured giant aneurysm was seen on the right and poor filling of the right anterior and middle cerebral artery was also observed (Fig. 2). An attempt was made to close the fistula by using propelling method (polyurethane foam emboli after Ohta's technique) with great success (Fig. 4). No special treatment was done to the left giant aneurysm. She is now in good condition 7 months after discharge.
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PMID:[Bilateral giant carotid aneurysm in the cavernous sinus with a carotid-cavernous fistula on one side, case report (author's transl)]. 123 76

In the present study, the ballooning pattern of the anterior mitral valve (AMV) in mitral valve prolapse (MVP) was investigated, and new diagnostic criteria for MVP were established using two-dimensional and Doppler echocardiography. The study population consisted of 164 patients with prolapse of the AMV alone, including 86 patients with idiopathic MVP, 52 associated with atrial septal defect (ASD), 17 having chordal rupture and nine associated with connective tissue disorders. There were 60 normal controls. The results were as follows: 1. The AMV was divided into two zones, clear and rough (CZ and RZ), according to the point of insertion of the strut chordae based on two-dimensional long-axis echocardiograms of the left ventricle. The severity of AMV prolapse was determined by an angle between the posterior aortic wall (PAO)-CZ and the CZ-RZ. a) Type A: Apparently there was a transitional point between CZ and RZ, despite normal PAO-CZ and CZ-RZ angles. The RZ showed mild ballooning or prolapse into the left atrium. b) Type B: Although the PAO-CZ angle was normal, the CZ-RZ angle was markedly narrowed. Therefore, prolapse of the RZ was more severe compared with that of type A. c) Type C: An overall zone of the AMV showed ballooning or prolapse into the left atrium due to a narrowed PAO-CZ angle. 2. Type B prolapse was frequently observed in idiopathic MVP (58%), the ASD group (71%) and the chordal rupture group (71%), and type C prolapse in MVP of connective tissue disorders (89%). 3. All of 18 patients (100%) with type A, 48 of 99 (48%) with type B, and 10 of 47 (21%) with type C could not be diagnosed as MVP using Gilbert's criterion. 4. Doppler mitral regurgitation (MR) was detected in 40 of the 47 patients (85%) with type C in 56 of the 99 (59%) with type B, and in seven of the 18 (39%) with type A. These results suggested that classification of the two-dimensional echocardiography of the AMV into two zones, clear and rough (CZ and RZ), could contribute to determining not only the severity of AMV prolapse, but also to the extent of myxomatous changes of the AMV and to evaluating the correlations between the degree of MVP and the incidence of MR.
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PMID:[Assessment of prolapsing pattern of the anterior mitral valve in mitral valve prolapse: new echocardiographic diagnostic criteria]. 264 77

This study concerns 51 cases of mitral valve prolapse demonstrated on bidimensional 4 cavities sonography according to Gilbert's criteria and aims to determine the frequency of the associated valvular involvement, anatomically with sonography and functionally with the Doppler test. Sonography demonstrates a tricuspid valve prolapse in 79 p. cent of the cases and an aortic valve prolapse in 10 p. cent. The Doppler test demonstrates a tricuspid leakage in 52 p. cent of the cases, a pulmonary leakage in 62 p. cent, and an aortic leakage in 18 p. cent. The myxoid degeneration found in 60 p. cent of the cases is a major factor in the occurrence of complications, especially progressive cardiac insufficiency (A). The myxoid degeneration defines therefore the "isolated prolapse disease" as opposed to "the prolapse without myxoid degeneration" which is a pure sonographic entity and probably a variation of the normal (A). This cardiac insufficiency occurs late during the 6th or 7th decade and is due to mechanical factors: prolapse, chords rupture and annular dilatation.
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PMID:[Idiopathic mitral valve prolapse and prolapse leakage. Study using Doppler ultrasound in 51 cases]. 327 67

Although two-dimensional echocardiography is a standard for diagnosing mitral valve prolapse, the diagnostic criteria are controversial. Regardless of valve ballooning we have used our criteria which are based on the dislocation of the mitral valve coaptation. The purpose of this study was to clarify the relationship between the location and the degree of mitral valve prolapse assessed by two-dimensional echocardiography and those of mitral regurgitation evaluated by color Doppler flow imaging, which enables us detailed analysis of regurgitation. Twenty-three patients with idiopathic mitral valve prolapse diagnosed by our criteria were studied. They were 14 men and nine women, ranging in age from 19 to 72 years (mean 44.7). In any patients, prolapse of either the anterior or posterior leaflet does not satisfy the Gilbert's criteria. Twenty of the 23 patients had mitral regurgitation by color Doppler flow imaging, and the grade was II, III or IV in 16 of these 20 patients. In 19 of 20 patients, the localization of the regurgitant jet flow from the mitral orifice coincided with the two-dimensional echocardiographic site of dislocation of mitral valve coaptation. Therefore, it was concluded that the dislocation of mitral leaflet coaptation detected by two-dimensional echocardiography is an abnormal finding regardless of the protrusion of the valve beyond the mitral ring.
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PMID:[Relationship of two-dimensional echocardiographic mitral valve prolapse to mitral regurgitation assessed by color Doppler flow imaging]. 350 30