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

Many patients with congenital heart disease now undergo cardiac surgery based solely on clinical and echocardiographic findings, but those with intracardiac shunts still frequently require cardiac catheterisation because there is no reliable non-invasive method of measuring the pulmonary artery pressure. Blinded to the haemodynamic results two independent observers retrospectively studied the cross sectional echocardiograms of 59 patients with uncomplicated ventricular septal defect to assess whether diastolic backward bowing of the pulmonary valve leaflets towards the right ventricular outflow tract (pulmonary valve prolapse) was associated with pulmonary hypertension. There was considerable interobserver variation in the diagnosis of pulmonary valve prolapse, but concordance was achieved in 27 cases. Mean pulmonary artery systolic and mean and diastolic pressures and the ratios of aortic to pulmonary artery mean pressures were all significantly higher for the group with pulmonary valve prolapse diagnosed by both observers than for the group without, thus showing an association between pulmonary valve prolapse and pulmonary hypertension. Further studies are warranted to determine the usefulness of this cross sectional echocardiographic sign in routine clinical practice.
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PMID:Significance of pulmonary valve prolapse. A cross sectional echocardiographic study. 646 12

Development of aortic valvular deformities was studied retrospectively in 395 inpatients with subarterial infundibular ventricular septal defect (siVSD). Aortic valvular deformities included prolapse into siVSD without aortic regurgitation (77 patients), prolapse and aortic regurgitation (95 patients), and aneurysm of the sinus of Valsalva (36 patients). No aortic valvular deformity was found in 187 patients, and 111 of these 187 patients had associated pulmonary hypertension. Prolapse and regurgitation of the aortic valve developed most frequently at the age 5 to 8 years. Aneurysm of the sinus of Valsalva was not found before the age of 10 years but began to develop during the teens and was diagnosed most frequently in the twenties. Patients with pulmonary hypertension did not develop aortic valvular deformities except in one instance. All inpatients with siVSD and without pulmonary hypertension over the age of 30 years had developed some aortic valvular deformities.
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PMID:Natural history of subarterial infundibular ventricular septal defect. 649 90

Echocardiograms were obtained from 48 Japanese children with ventricular septal defect (16 having aortic cusp prolapse, Group I, and 32 without it, Group II). In the case of right coronary cusp prolapse, the right coronary sinus protrudes anteriorly into the right ventricular outflow tract, and thus, the anteroposterior diameter of the aortic root increases. In the case of non-coronary cusp prolapse, the non-coronary sinus bulges posteriorly into the right ventricle, and thus, the aortic root increases in size. For evaluating the degree of these prolapses quantitatively, we measured the aortic root diameter echocardiographically and expressed them as a percent of a normal one. In Group I the aortic root diameter was 131 +/- 9% (mean +/- SD) and in Group II it was 105 +/- 7%, and the difference between the 2 groups was statistically significant (p less than 0.001). In Group I 14 of the 16 patients had a value greater than 120%, while all 32 patients of Group II had a value smaller than 120%. Thus, in children with ventricular septal defect, an aortic root diameter greater than 120% of normal suggests the presence of aortic cusp prolapse. Systolic semiclosure of the aortic valve was found in 8 patients of Group I (50.0%) and in 2 of Group II (8.7%). Coarse systolic fluttering of the pulmonary valve with an amplitude of greater than 3 mm was detected in 6 of Group I (40.0%) and in 3 of Group II (10.0%). Therefore, semiclosure of the aortic valve and fluttering of the pulmonary valve are considered to be also useful for evaluating aortic cusp prolapse qualitatively.
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PMID:Echocardiographic evaluation of aortic cusp prolapse in children with ventricular septal defect. 665 90

The results of surgery on five patients aged between 4 and 14 years old with ventricular septal defect (VSD) and aortic incompetence (AI) are reported. Four of the five patients had massive AI, the diastolic blood pressure being 0 in 3 cases. All patients underwent catheterisation and angiography. In 1 case, an aneurysm of the sinus of Valsalva bulging into the infundibulum was detected. At operation, 3 infra-cristal, 1 supra cristal and 1 unclassified VSD were observed. Prolapse of the aortic cusps was present in three cases, and in two cases these lesions were complicated by infective endocarditis. Three patients were managed by a slightly modified version of Trusler's aortic valvuloplasty, and the two patients with endocarditis underwent aortic valve replacement. The VSD was closed by Dacron patch in 3 cases and directly in 2 cases. The immediate postoperative period was complicated in one case by haemorrage due to anticoagulant therapy causing tamponade and paraplegia. In the other four cases, there were no complications. The results of valvuloplasty were good with complete regression of the diastolic murmur. The medium-term results were good, with a maximum follow-up period of 21 months. One of the patients with an aortic valve prosthesis has minimal AI, probably due to a paravalvular leak. A number of points are discussed with respect to this small series of patients: anatomy, techniques, indications. The modified Trusler's valvuloplasty is recommended, even in cases of severe AI.
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PMID:[Surgical treatment of interventricular communication with aortic insufficiency. Apropos of 5 cases]. 677 28

Rupture of a Sinus of Valsalva aneurysm into the pulmonary infundibulum with ventricular septal defect was diagnosed by M mode echocardiography The differential diagnosis was prolapse of an aortic valve cusp associated with ventricular septal defect. The relevant features were the presence of an echo anterior to the anterior aortic wall. This echo was related to the aortic valve as a small posterior movement was recorded at aortic valve closure. Systolic fluttering of the pulmonary valve suggested a degree of subvalvular obstruction. Diastolic fluttering was related to the aortic regurgitation immediately below the pulmonary valve. This case confirms the hypothesis that the anterior echo produced by the aortic valve is in fact the left anterior coronary cusp.
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PMID:[Aneurysm of the sinus of Valsalva rupturing into the pulmonary infundibulum. Echographic study]. 679 84

Although more defects in the muscular ventricular septum close spontaneously than do defects abutting on the membranous septum (perimembranous defects), a good proportion of the latter show a tendency to diminish in size and to close. The mechanism responsible for this closure is usually described as an aneurysm of the membranous septum, although some doubt has been cast as to whether this is the precise mechanism. In this study, 69 unoperated hearts with ventricular septal defect were examined; 26 (38%) showed some evidence of partial closure and none extended exclusively into the outlet part of the septum. Two thirds of the trabecular perimembranous defects, almost half of the inlet defects, and one third of the confluent defects showed signs of partial occlusion. The anatomic structures most frequently responsible were reduplication of tricuspid valve tissue (16 cases), adhesion of tricuspid valve leaflets (6 cases), and prolapse of an aortic valve leaflet (3 cases). Only in 2 cases were subaortic tissue tags observed which might have originated from the remnant of the membranous septum. The present study shows that although anatomic evidence of partial closure was present in two fifths of the hearts studied, only rarely was it due to so-called aneurysm of the membranous septum.
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PMID:Mechanisms of closure of perimembranous ventricular septal defect. 686 84

Four children with systolic thrills and harsh pansystolic murmurs in the second left and right intercostal spaces, radiating to the base of the neck, and suspected of having a subaortic ventricular septal defect and possible aortic prolapse underwent angiocardiography using axial projections. All demonstrated an unusual "tunnel-like" track into the right ventricle and no subaortic ventricular septal defect or prolapse. In our opinion, these physical findings suggest this abnormality and that axial angiography clearly delineates the lesion.
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PMID:Delineation of tunnel-like-ventricular septal defects in young children by axial cineangiography. 687 5

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

Nineteen patients with types I and III Ehlers-Danlos syndrome were hospitalized at our institution between 1973 and 1978. Chest roentgenogram, electrocardiogram, and echocardiogram were done; 11 patients underwent cardiac catheterization. Thirty-five cardiac or great vessel abnormalities were detected. Fifteen patients had nitral valve prolapse; six also had tricuspid valve prolapse. Dilatation of the aortic root or extasia of the sinuses of Valsalva, or both, occurred in six patients. Dilatation of the pulmonary artery and annulus caused pulmonary regurgitation in one patient. Congenital heart defects included bicuspid aortic valve (two), pulmonary valvular stenosis (one), ventricular septal defect (two), and an atrial septal defect (one). The apparent high prevalence of cardiovascular abnormalities in hospitalized patients with types I and III Ehlers-Danlos syndrome necessitates a careful cardiovascular evaluation. Conversely, Ehlers-Danlos syndrome types I and III should be excluded in patients with mitral or tricuspid valve prolapse, great vessel dilatation, and congenital heart defects.
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PMID:The spectrum of cardiac defects in the Ehlers-Danlos syndrome, types I and III. 735 21

Five patients with tetralogy of Fallot associated with aortic insufficiency were studied. They ranged from 6 to 34 years old (mean, 14 years), and 2 patients had a history of subacute bacterial endocarditis. Four patients had a bulboventricular type of ventricular septal defect. Prolapse of the right coronary cusp was the main cause of aortic insufficiency. Deformed valve secondary to subacute bacterial endocarditis and severe dilatation of the aortic annulus were the other causes. In addition to repair of the tetralogy defect, aortic valvuloplasty was performed in 2 patients. In the remaining 3 patients, the ventricular septal defect was closed with a relatively small-sized patch and no aortotomy was made. Four patients survived the operation, and no residual aortic insufficiency was observed in 3 of them. The etiology and the method of operation are discussed.
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PMID:Tetralogy of Fallot associated with aortic insufficiency. 738 46


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