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

This report reviews the clinical features of 80 patients with roentgenographically proved mitral annular calcification. The mean age of the group was 73 years, and there was a 2.5 to 1 female to male ratio. Evaluation for underlying cardiovascular disease revealed six patients with severe calcific valvular aortic stenosis; five patients with hypertrophic cardiomyopathy, 11 with mitral prolapse and 33 with significant arterial hypertension (blood pressure greater or equal to 150/96 mm Hg). Eighty-five per cent of the group (68 of 80 patients) had an underlying cardiac disorder associated with either chronically increased left ventricular systolic pressure or abnormal leaflet motion. Other cardiovascular abnormalities occurring as complications secondary to the mitral ring calcification included subacute bacterial endocarditis (three cases), arterial emboli (five episodes) and high grade atrioventricular block (16 cases). Twelve patients had severe mitral regurgitation; successful mitral valve replacement was carried out in four patients (all with myxomatous mitral tissue). Evidence of diffuse conduction system disease, not limited to the area of the cardiac fibrous skeleton, was found frequently (44 patients). Nine patients had sinus node dysfunction and 35 patients had electrocardiographic evidence of distal intraventricular (fascicular) block. Twenty-one patients eventually required pacemakers for management of symptomatic bradyarrhythmias. Atrial fibrillation was present in 23 patients. In this review it was found that calcification of the mitral annulus is frequently associated with or induces serious cardiovascular disease. Since some of these disorders may be modified by appropriate therapy, calcification of the mitral annulus should no longer be ignored as a benign marker of the elderly heart.
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PMID:Calcification of the mitral annulus: etiology, clinical associations, complications and therapy. 15 99

To document the assumed benign prognosis of premature ventricular contractions in children, we followed 17 patients with PVCs and without other heart disease for a mean of seven years (range one to 19 years). Data were collected from the history, physical examination, 15-lead ECG, and treadmill exercise test. Eight of the 17 children still had PVCs at the most recent follow-up. Of these eight children, seven were asymptomatic. The physical examination remained normal in all except one, who developed signs of mitral prolapse. Light exercise abolished the PVCs in all children. We believe that if a careful clinical examination discloses no abnormalities, and if the PVCs are unifocal and disappear with exercise, this dysrhythmia is, in fact, benign in children, and requires no further cardiovascular examination.
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PMID:Premature ventricular contractions in normal children. 61 77

Intending to find out which is the prevalence of mitral valvular prolapse in cases of ischemic cardiopathy with "normal" coronariography, a review was made of the coronary-ventriculographic studies at the I.N.C. archives, which showed as clinical diagnosis that of ischemic cardiopathy with "normal" coronaries. In the present studies we record 47 cases showing chest angina and/or electrocardiographic changes in rest or effort tests, compatible with myocardic ischemia and coronariography undoubtedly normal. We found 30 cases (63.8%) showing strong evidence of mitral prolapse in the left cineventriculography taken in right-front oblique position.
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PMID:[Prolapse of the mitral valve]. 70 34

For half a century the systolic click and late systolic murmur lay dormant as innocent auscultatory curiosities. The thirteen years since Barlow related these phenomena to mitral leaflet prolapse have witnessed an astonishing information explosion. We have sought to bring together the accumulated data in this review. An Historical Perspective traces the evolution from the now abandoned "pericardial" or "extracardiac" phases, through the leafletchordal phase (redundancy), the myocardial phase (segmental left ventricular contraction abnormalities), to the anular phase (dilatation and faulty systolic contraction). Functional Anatomy is dealt with in terms of pathology, pathophysiology, hemodynamics, angiocardiography, echocardiography, and physical and pharmacological interventions. Clinical Manifestations are concerned with prevalence, natural history, symptoms, physical signs, electrocardiographic abnormalities and roentgen fingings. The four Major Complications- sudden death, infective endocarditis, spontaneous rupture of chordae tendineae, and progressive mitral regurgitation- are examined. Associated Cardiac Diseases, i.e., Marfan's syndrome, ostium secundum atrial septal defect and atherosclerotic coronary artery disease, are discussed, and a section on Treatment deals chiefly with prophylaxis for infective endocarditis and the management of arrhythmias and chest pain. A final section on Evolving Information considers etiologic concepts, the nature of left ventricular contration abnormalities, the cause of chest pain, the relationship to Marfan's syndrome and ostium secundum atrial septal defect, and the effect of aging and sex differences on leaflet chordal redundancy.
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PMID:Mitral valve prolapse. 77 40

Postexercise systolic time intervals (STI) were measured in ten patients (PMV group) with auscultatory evidence of the midsystolic click syndrome (i.e. one or more systolic nonejection clicks alone or in association with the late systolic murmur), and compared to eight age-matched volunteers (control group) with no evidence of heart disease. Following measurement of supine STIs, the subjects pedalled an upright bicycle ergometer at progressive work loads until a target heart rate (HR) representing 85% of the age-adjusted maximum was attained, or an abnormal end point was noted. Immediately postexercise, a repeat measurement of STIs, was obtained. A shortened or unchanged postexercise left ventricular ejection time corrected for HR (deltaLVETc) and a marked shortening of total electromechanical systole after exercise (deltaQS2c) constituted a normal STI response to stress testing and was noted in all control subjects. All of the PMV group exhibited evidence of left ventricular dysfunction characterized by a prolonged deltaLVETc. It is concluded that an abnormal STI response to exercise consistent with left ventricular dysfunction can be demonstrated in patients with prolapse of the mitral valve by the response of the STI.
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PMID:Postexercise systolic time intervals in the midsystolic click syndrome. 87 54

Straited membranous structures (SMS), which consisted of sheets or ribbons of 130 to 220 A in thickness, showed variable patterns of periodic substructure, and resembled SMS described in renal and ocular tissues in various diseases, were found in extracellular locations in a) mitral valve (2 patients) and tricuspid valve (1 patient) of 2 patients with mitral valvular prolapse, b) mitral valve and femoral artery of 1 patient with Marfan's syndrome and prolapsed mitral valve, and c) myocardium (2 patients) and thickened endocardium (3 patients) of 3 patients with congenital heart disease associated with muscular obstruction to right ventricular outflow. Striated membranous structures measured up to several microns in diameter, often were highly folded and convoluted, and sometimes appeared circular in outline. Some SMS measured from 130 to 150 A in thickness and had indistinct edges and poorly defined periodicity. The majority of SMS, however, had greater thicknesses, in the range of 200 A, and a periodicity characterized by alternating light and dark bands with a spacing that varied from 100 to 160 A. The structures were associated with thickened basement membranes, elastic fibers, and membrane-bound bodies of the type thought to be involved in elastogenesis. Evidence available suggests that SMS results from an unusual pattern of arrangement of a component, possibly Type IV collagen, of basement membrane material.
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PMID:Striated membranous structures in human hearts. An ultrastructural study. 97 Apr 44

Two sibs with trisomy for the long arm of chromosome 19 are reported. The common features included flat facial profile with microcephaly, hypertelorism, ptosis, prominence of the glabella, small nose with anteverted nostrils and a characteristic fish-shaped mouth. In addition congenital heart disease, physical retardation and seizures were seen in both sibs. That tristomy 19q can be suspected clinically is emphasized.
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PMID:Trisomy 19 q. 108 17

Without treatment, about 60% of atrial arrhythmia patients suffer a relapse within 3 months and 70% within one year. Antiarrhythmic treatment intended to reduce this percentage is therefore justified, on condition that it is well tolerated. Several preliminary questions have to be settled before this medical prophylaxis: 1) Justification of antiarrhythmic treatment (sometimes pointless to deal with very occasional episodes); 2) Treatment of the underlying heart disease (valve disease, cardiothyrotoxicosis, etc.) or promoting factors (potassium depletion etc.); 3) Accurate assessment of any associated conduction abnormalities, which may constitute a contraindication to antiarrhythmic treatment (WPW syndrome in the case of verapamil and the digitalis-like drugs) or require additional treatment (pacemaker); 4) Definition of the mechanism (vagal or sympathotonic) inducing arrhythmia; 5) Evaluation of the hemodynamic parameters of the underlying heart disease (size of the atria, ventricular function, coronary or valvular lesions) which may limit the efficacy of the treatment. Once these parameters have been identified, the primary treatment should be type la or lb antiarrhythmics, which have been shown to be effective, despite the fact that they are not without arrhythmic risks (the Ib antiarrhythmics are less effective and have a poor safety profile). The beta-blockers have preferential indications (hypersympatheticotonia, hyperthyroidism, hypertrophic myocardiopathy, mitral prolapse, angina etc.) and can be replaced by verapamil or bepridil if there are non-cardiac contraindications (ulcers, asthma, diabetes). Amiodarone is extremely effective, but its poor extracardiac safety restricts its long-term use. Complementary treatments (digitalis-like, anticoagulants or anti-PAF and cardiostimulant drugs) should be added if necessary. Recurrences (to be confirmed by ECG or Holter) should lead to rigorous confirmation of therapeutic compliance and observance of simple hygienic and dietary measures (no excessive exertion, elimination of stimulants etc.). With strict clinical and ECG monitoring, it would then be possible either to increase the dose levels (accompanied by plasma determinations if possible) or to switch to a treatment with more effective, but more aggressive drugs (amiodarone, flecainide) or to use drug associations (la and lb, la and II etc.). Repeated failure of such attempts should lead to a non-medical approach to treatment.
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PMID:[Preventive drug therapy of recurrence of atrial fibrillation]. 129 92

We report the cases of eight children with Marfan syndrome. Seven (87.5%) were diagnosed with cardiopathy, everyone with auscultatory findings. Electrocardiographic patterns were nonspecific. Enlargement of the aortic root was present in two of the cases as seen by thorax x-rays. Echocardiography detected the presence of mitral valve prolapse in 87.5% of the patients (7 cases) and aortic enlargement in 75% of the patients (6 cases). Echocardiography also detected the presence of aortic dysplasia, tricuspid valve prolapse and right and left ventricular hypertrophy. During the follow-up period, no case had cardiac failure. There was no mortality. The aortic enlargement was progressive and was not modified by propranolol treatment. Surgical treatment was not needed. Family history related to this condition was present in a very small percentage (37.5%). We comment on one infantile form of Marfan syndrome with its own phenotype different from that of classical Marfan syndrome.
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PMID:[Marfan syndrome in childhood: cardiovascular manifestations. Echocardiographic changes]. 141 16

Electrophysiological tests were performed in 60 patients aged between 18 and 63 years (mean age 38 years), and divided into two groups: with mitral valve leaves prolapse syndrome, and without this abnormality, in whom no other heart disease was diagnosed. Refraction of the right atrium, atrio-ventricular node, and right ventricle was evaluated together with cardiac response to different types of electrostimulation. A supraventricular dysrhythmia (most frequently atrial fibrillation) has been produced in 17 patients (42.5%) with mitral valve leaves prolapse syndrome whereas in the control group the same was produced in 2 patients (10%). Programmed stimulation of the ventricles did not produce ventricular tachycardia in none patient of both groups. Multiple ventricular beats have been produced in 3 patients with mitral valve prolapse syndrome and pairs of ventricular beats in other 3 patients of this group. Results suggest that "arrhythmogenic tendency", especially supraventricular dysrhythmia is more frequent in patients with mitral valve prolapse syndrome than in the general population.
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PMID:[Programmed atrial and ventricular stimulation in patients with mitral valve prolapse--a personal experience]. 143 74


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