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

A 56-year-old woman was admitted to our department because of congestive heart failure. Chest X-ray showed dextrocardia with situs inversus. The echocardiography revealed severe mitral regurgitation due to prolapse of posterior leaflet and secondary Venography demonstrated the bilateral superior vena cava, huge coronary sinus and hemiazygos continuation with hypoplastic inferior vena cava. Mitral valve regurgitation was repaired by Carpentier's and Burr's technique, and tricuspid valve regurgitation was repaired by Kay's technique. Her postoperative course was uneventful. Valve surgery for acquired valvular lesion in dextrocardia with situs inversus is rare. Although valve repair is easily performed even in mirror-image heart as well as in normal, levo-position heart, preoperative evaluation of systemic venous return is important in the case of dextrocardia with systemic venous anomalies.
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PMID:[An experience of successful valve repair for acquired mitral and tricuspid regurgitation in dextrocardia, situs inversus, bilateral vena cava, and hemiazygos continuation]. 799 Feb 78

The question of whether to repair or replace the mitral valve in the elderly remains unanswered. The purpose of our study is to describe our experience with mitral valve repair (MVR) using Carpentier's technique in patients 70 years and older. Fifty consecutive patients underwent MVR between 1984-1992. There were 30 female patients. All had 2 + or more mitral regurgitation (MR). The valve pathology included ischemic (n = 28), myxomatous (n = 7) and rheumatic (n = 6), leaflet prolapse (n = 11) and healed bacterial endocarditis (n = 3). The clinical findings included: myocardial infarction (n = 17), congestive heart failure (n = 18), atrial fibrillation (n = 14) and pulmonary hypertension (n = 10). The surgical technique involved placement of a Carpentier ring (n = 41) or Duran ring (n = 3), resection of leaflets (n = 9), shortening of the chordae (n = 8) and commissurotomy (n = 6). At surgery, coronary bypass was carried out in 32 patients while the aortic valve was replaced in five and repaired in one. Postoperative complications included atrial fibrillation (n = 14), transient neurologic events (n = 4), heart block requiring pacemaker (n = 3) and prolonged intubation (n = 4). Echocardiogram carried out postoperatively showed 2 + MR in three patients, 1 + in four, and a trace or none in the remaining (n = 39). No patient required re-operation for MR. Three patients (6%) died within 30 days after surgery due to low output (n = 1), malignant ventricular arrhythmia (n = 1) and heart block with cardiac arrest (n = 1).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Mitral valve repair in patients over the age of 70 years. 808 76

Historically, indications for ventricular septal defect closure have included congestive heart failure, pulmonary hypertension, aortic insufficiency with or without aortic valve prolapse, and prior bacterial endocarditis. However, controversy exists as to how the lifetime risk of an isolated, nonoperated restrictive ventricular septal defect compares with the risk of surgical closure in an asymptomatic child. Between 1980 and 1991, cardiac catheterization and elective ventricular septal defect closure (age > 1 year, pulmonary to systemic flow ratio < 2.0) were performed in 141 patients aged 1 to 23 years (mean age, 6.1 +/- 4.7 years). Mean systolic pulmonary artery pressure was 26.9 +/- 13.0 mm Hg, and mean pulmonary to systemic flow ratio was 1.6 +/- 0.3. Aortic valve prolapse was present in 63 patients (45%), aortic insufficiency was present in 25 (18%), and 5 (3.5%) had prior bacterial endocarditis. There were no early or late deaths or major morbidity. No patient required a ventriculotomy to accomplish ventricular septal defect closure. Mean postoperative intensive care unit stay was 1.3 +/- 0.9 days, and mean hospital stay was 5.5 +/- 1.9 days. There were no instances of permanent complete atrioventricular dissociation, reoperations for bleeding, postoperative wound infections, or reoperations for residual or recurrent ventricular septal defect. These improved results justify a reevaluation of historic indications for ventricular septal defect closure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Restrictive ventricular septal defect: how small is too small to close? 823 92

Symptoms of fatigue and activity impairment, atypical precordial pain, and cardiac arrhythmia frequently precede by years the development of congestive heart failure. Of 115 patients with these symptoms, 60 were diagnosed as having hypertensive cardiovascular disease, 27 mitral valve prolapse syndrome, and 28 chronic fatigue syndrome. These symptoms are common with diastolic dysfunction, and diastolic function is energy dependent. All patients had blood pressure, clinical status, coenzyme Q10 (CoQ10) blood levels and echocardiographic measurement of diastolic function, systolic function, and myocardial thickness recorded before and after CoQ10 replacement. At control, 63 patients were functional class III and 54 class II; all showed diastolic dysfunction; the mean CoQ10 blood level was 0.855 micrograms/ml; 65%, 15%, and 7% showed significant myocardial hypertrophy, and 87%, 30%, and 11% had elevated blood pressure readings in hypertensive disease, mitral valve prolapse and chronic fatigue syndrome respectively. Except for higher blood pressure levels and more myocardial thickening in the hypertensive patients, there was little difference between the three groups. CoQ10 administration resulted in improvement in all; reduction in high blood pressure in 80%, and improvement in diastolic function in all patients with follow-up echocardiograms to date; a reduction in myocardial thickness in 53% of hypertensives and 36% of the combined prolapse and fatigue syndrome groups; and a reduced fractional shortening in those high at control and an increase in those initially low.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Isolated diastolic dysfunction of the myocardium and its response to CoQ10 treatment. 824 99

We reported an autopsy case with recent memory disturbance, characterized by localized atrophy of parahippocampal gyrus, subiculum and amygdala. This patient initially exhibited recent memory disturbance at the age of 73. She was disoriented to time and place and immediately forgot having had a meal. At the age of 75, she was hospitalized because of progressive forgetfulness and congestive heart failure. One year later, she was admitted to our medical center. On admission, she was alert, but showed severe recent memory disturbance and disorientation to time and place. By contrast, she had neither aphasia nor apraxia. No other neurological symptoms were found. Brain CT showed localized atrophy of the medial part of bilateral temporal lobes and brain SPECT (123I-IMP) revealed a decrease of cerebral blood flow in the same regions. We considered her as early stage of Alzheimer type dementia (ATD) clinically. She died of pneumonia and DIC at the age of 78. Her illness lasted about 5 years. General autopsy showed prolapse of mitral valves, bronchopneumonia and DIC. The brain weighed 1,150 gm. Coronal sections of the brain revealed locarized atrophy of bilateral mediobasal part of the temporal lobes including the rostral parahippocampal gyrus, subiculum and amygdala. There were severe neuronal loss with astrogliosis and a few neurofibrillary tangles (NFT) in the rostral para-hippocampus, CA1 of the hippocampal formation, prosubiculum and amygdala. There were neither senile plaques (SP) nor NFT in the cerebral neocortex. This case lacked neocortical SP and NFT and showed bilateral localized atrophy of rostral parahippocampal gyrus, CA1, subiculum and related structure of the ventromedial temporal lobe with severe neuronal loss and astrogliosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[An autopsy case with recent memory disturbance, characterized by localized atrophy of parahippocampal gyrus, subiculum and amygdala]. 833 75

Double-chambered right ventricle (DCRV) is commonly associated with ventricular septal defect (VSD). In this study, an assessment was made of the relevance of a malalignment-type VSD to hemodynamic and morphologic features in DCRV. During an 8.5-year period, 53 patients with DCRV were enrolled after study with echocardiography, catheterization, and angiography. Patients were divided into 2 groups: group I included 40 patients, aged 3.7 +/- 3.2 years, with a malalignment-type VSD; group II consisted of 13 patients, aged 8.6 +/- 2.7 years, without a malalignment-type VSD. History of congestive heart failure in infancy was present in 21 group I and 2 group II patients (53% vs 15%, respectively, p <0.05). The mean pulmonary-to-systemic flow ratio was significantly higher in group I than in group II (1.89 +/- 0.74 vs 1.14 +/- 0.21, respectively, p <0.05). The mean pressure gradient across the right ventricular outflow tract was lower in group I than in group II (41 +/- 16 vs, 73 +/- 33 mm Hg, respectively, p <0.05). Among 42 patients who had a series of echocardiograms recorded, progression of pressure gradient was evident in 35: 28 in group I and 7 in group II. A subaortic ridge was present exclusively in 29 group I patients (73%). Prolapse of the aortic valve was present in 26 (49%): 20 group I (50%) and 6 group II (46%) patients. Aneurysm formation of the septal defect was found in 17 (43%) and 7 (54%) group I and II patients, respectively. It can be concluded that a history of congestive heart failure was more common in DCRV patients with a malalignment-type VSD. Malalignment-type VSD is significantly associated with a larger pulmonary-to-systemic flow ratio and subaortic ridge.
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PMID:Malalignment-type ventricular septal defect in double-chambered right ventricle. 862 36

Mitral valve prolapse (MVP) is a commonly diagnosed condition with varied clinical presentations but local data is lacking. In our study, we reviewed 98 patients (54 males, 44 females) with echocardiographic mitral valve prolapse diagnosed between 1991 and 1993 to study the clinical profile and echocardiographic features of patients with this condition in our local population. The mean and median age at presentation/detection were 42 years and 38 years respectively. The majority of the patients were asymptomatic (59%); the rest presented with palpitations (21%), congestive heart failure (4%) and infective endocarditis (5%). On clinical examination, 64 patients had mitral regurgitation (13 patients had both mitral regurgitation murmur and a systolic click), while one or more systolic clicks were heard in another 32 patients. Six patients also had associated Marfan syndrome. 2D echo revealed isolated anterior and posterior leaflet involvement in 55 and 19 patients respectively. Another 24 patients had involvement of both leaflets. Mitral regurgitation was detected on colour Doppler study in 78 patients. Nine patients had associated tricuspid valve prolapse. Of the 98 patients, 8 patients developed flail mitral valve. Four were detected at presentation/diagnosis, while the other 4 were diagnosed incidentally on routine follow-up 2D echo. Of these 8 patients, one developed cardiac failure. The patients had been on follow-up for a mean period of 9 months. During this period, mitral regurgitation progressed in 3 patients resulting in valve surgery. Only 20 patients had arrhythmias detected on ambulatory ECG monitoring, most of them were frequent atrial and ventricular premature beats. No patient was found to have haemodynamically significant arrhythmia. In summary, most patients with MVP had anterior mitral valve leaflet prolapse and mitral regurgitation. Although most patients with MVP are asymptomatic or have minor symptoms, it is associated with significant morbidity.
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PMID:Clinical and echocardiographic features of mitral valve prolapse patients in a local population. 894 49

A 9-year-old 3-kg spayed Maltese with congestive heart failure that did not respond to aggressive medical treatment underwent cardiopulmonary bypass and mitral valve repair. Prior to surgery, echocardiography revealed a markedly dilated mitral annulus, left atrium, and left ventricle; prolapse of the parietal mitral valve leaflet; and mitral regurgitation. Hilar pulmonary edema was evident on thoracic radiographs. After surgery, echocardiographic measurements of the heart returned to reference range, all medication was discontinued, and the dog did not have clinical signs of heart disease.
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PMID:Mitral valve reconstruction in a toy-breed dog. 894

We report here a case of a premature baby with tetralogy of Fallot and bicuspid aortic valve. After the successful completion of the Blalock-Taussig (BT) shunt, severe aortic valve regurgitation (AR) appeared, although it was trivial preoperatively. Severe postoperative heart failure was induced by progression of the AR. Postoperative echocardiography revealed that the progression of the AR was provoked by appearance of prolapse of the cusp as the result of rapid increase of blood flow through the aortic valve after the BT shunt. We propose that, in planning the BT shunt for patients with tetralogy of Fallot, preoperative examinations for a possible bicuspid aortic valve should be done and postoperative precaution considering possible appearances of severe AR and congestive heart failure will be necessary.
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PMID:Symptomatic aortic regurgitation after Blalock-Taussig shunt in tetralogy of Fallot with bicuspid aortic valve. 936 9

Mitochondrial disorders are a group of diseases that can affect virtually all organ systems. A 19 year old man was seen in 1993 with neurologic abnormalities consisting of impaired function of muscles, diplopia, progressive loss of vision, impaired phonation and swallowing, during the last 10 years. Physical examination disclosed moderate wasting of the four limb muscles, mild motor weakness of neck muscles, symmetrical hyporeflexia, cerebellar dysfunction, severe external ophtalmoplegia and ptosis. Fundii oculi examination showed retinitis pigmentosa. The electromyogram demonstrated myopathic changes with normal nerve conduction velocities. The cerebrospinal fluid was normal, except for a mild increase in lactic acid. Histochemical study of a muscle biopsy specimen demonstrated ragged red fibers and increase of the subsarcolemal oxidative activity of mitochondriae. The diagnosis of Kearns-Sayre disease was confirmed and he was discharged advising physical therapy. On February 1995, he was again admitted, this time with right cardiac failure and worsening of all his previous symptoms and signs. He complained of myalgias and his muscle weakness was more striking on clinical examination. Echocardiography showed biventricular dilatation and left ventricular hypertrophy with preserved systolic function. A new muscle biopsy revealed an heteroplasmic deletion of 5 Kb with 80% of mutant mitochondrial DNA. In brief, we report a patient with the clinical phenotype of Kearns-Sayre syndrome who presented an acute congestive cardiac failure due to cardiomyopathy, an association which has seldom been, reported in the literature.
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PMID:[Severe cardiac failure in Kearns-Sayre syndrome]. 943 73


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