UMLS:C0033377 - FACTA Search

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Query: UMLS:C0033377 (prolapse)
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It has been reported that Kawasaki syndrome is accompanied with mitral regurgitation or aortic regurgitation in some cases. To elucidate the incidence and the natural history of valvular heart disease in Kawasaki syndrome, we analyzed the patients who were detected to have a new heart murmur after the onset of Kawasaki syndrome. From 1973 to 1988, we have experienced 13 cases with valvular heart disease in 1215 cases of Kawasaki syndrome, 12 cases with mitral regurgitation (1.0%) and one with aortic regurgitation (0.1%). Valvular lesions were confirmed by angiography or pulsed Doppler echocardiography. The age at onset of Kawasaki syndrome, the duration of fever, the maximum erythrocyte sedimentation rate, and the incidence of coronary artery lesions in these cases were compared with the same variables in 30 cases of without valvular lesion in Kawasaki syndrome. There were no statistical difference between the cases with valvular heart disease and without valvular heart disease about the age of onset (mean +/- SD 10.2 +/- 12.7 months vs 20.8 +/- 18.4 months; N.S.) and the maximum erythrocyte sedimentation rate (87.7 +/- 29.0 mm/h vs 87.2 +/- 35.6 mm/h; N.S.). Whereas the duration of fever in cases of valvular heart disease was more extended than those without valvular heart disease (20.3 +/- 8.1 days vs 10.3 +/- 4.3 days; p less than 0.001), and the incidence of coronary artery lesions in the cases of valvular heart disease was significantly higher than those without valvular heart disease (12/13 cases vs 7/30 cases; p less than 0.001), thus suggesting that the cases of valvular heart disease were subject to a severe case of Kawasaki syndrome. All valvular heart disease appeared within 1 month after the onset of Kawasaki syndrome, except in one case whose heart murmur was noticed 5 years after the onset. The heart murmur disappeared within 2 months after the onset of valvular heart disease in 5 cases, however in another 7 cases, the heart murmur persisted more than 2 years (mean; 5.3 years to date) or one has died of acute congestive heart failure due to mitral regurgitation. All cases with persistent valvular disease revealed mitral or aortic valve prolapse. Our data suggest that the cause of valvular heart disease might be different by the time of onset and duration of valvular heart disease.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Valvular heart disease in Kawasaki syndrome--incidence and natural history. 263 47

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

A 63-year-old man with double orifice mitral valve (DOMV) and bicuspid aortic valve was reported. Preoperative echocardiography showed prolapse of the posterior leaflet and mitral regurgitation but was unable to show the existence of the duplication of the mitral valve. He underwent aortic and mitral valve replacement and did well after surgery. DOMV is a rare congenital malformation, and DOMV associated with bicuspid aortic valve is the first reported case in Japan.
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PMID:[Double orifice mitral valve associated with bicuspid aortic valve]. 268 31

We have used cross-sectional real time color-coded Doppler echocardiography to characterize the patterns of the regurgitant jet seen in mitral valvar disease of different etiologies. We studied 118 patients with mitral regurgitation due to rheumatic valve disease (n = 26), hypertrophic obstructive cardiomyopathy (n = 22), dilated cardiomyopathy (n = 35) and prolapse of the leaflets of the mitral valve (n = 35). We analyzed the origin, spatial distribution, extent and duration of the regurgitant jet. A semiquantitative grading system was used to evaluate the extent of the jet by measuring its maximal area and the duration of regurgitant flow. Typical flow patterns could be observed in hypertrophic obstructive cardiomyopathy, (in which the crescent shaped jet was elongated in midsystole and directed posteriorly) in dilated cardiomyopathy (in which oval shaped jets were observed throughout systole) and in prolapse of the leaflets (in which early or late systolic regurgitant jets occurred with an eccentric "drop-like" pattern, being directed posteriorly in patients with a prolapse of the aortic leaflet and anteriorly in those with a prolapse of the mural leaflet of the valve). A large variety of patterns was found in rheumatic disease due to the individual deformation of the leaflets. A comparison of the measured area of the jet revealed no significant differences between regurgitation caused by rheumatic valve disease and dilated cardiomyopathy. The regurgitation in 80% of these patients was of moderate to severe degree. In contrast, regurgitation due to prolapse of the leaflets or hypertrophic obstructive cardiomyopathy appeared to be of mild to moderate degree in 90% of cases.
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PMID:Flow patterns of mitral regurgitation due to different etiologies: analysis by color-coded Doppler echocardiography. 272 90

Mitral valve prolapse is frequent in childhood. The use of two-dimensional echocardiography may enable more accurate diagnosis and assessment of the degree of valve involvement. Twenty five (1.9%) of all children studied by two-dimensional echocardiography fulfilled the diagnostic criteria for mitral valve prolapse. In 48% it was associated to a different congenital heart as normality. The apical four chamber and parasternal long and short axis views were used, and cases were graded according to the severity of the prolapse. Diagnosis was made in 44% of cases by the apical four chamber view, which was the best projection to detect the abnormality. Cases of moderate and severe prolapse were also detected in the parasternal long axis view. All patients were asymptomatic but they were all controlled detect progression to mitral insufficiency of the appearance of other complications.
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PMID:[Prolapse of the mitral valve. Study using bidimensional echocardiography]. 277 73

This study was performed to evaluate the incidence and genesis of systolic anterior motion (SAM) of the mitral valve apparatus in patients with aortic regurgitation (AR). The study population consisted of 44 patients with non-rheumatic AR, without significant aortic stenosis or mitral regurgitation. The presence and location of SAM in the short-axis view were determined by M-mode echocardiography guided by two-dimensional echocardiography. The extent and direction of the regurgitant jet were decided by pulsed or two-dimensional Doppler echocardiography. SAM was observed in 21 (48%) of the 44 patients, and it was more frequently observed in patients with an etiology of aortic valve prolapse or annuloaortic ectasia than in those of other etiology (10/14 vs 10/30; p less than 0.05). Twenty-eight patients whose regurgitant jet was directed posteriorly and impinged on the mitral valve apparatus had a significantly higher incidence of SAM than did the other 16 patients (18/28 vs 3/16; p less than 0.01). In eight of 10 patients in whom the direction of the regurgitant jet could be precisely observed by two-dimensional Doppler echocardiography. SAM was observed at the place where a regurgitant jet was directed along the anterior mitral valve in the short-axis view. M-mode measurements (LVDd, LVDs, %FS, LVDd-LVDs) of the patients with SAM had greater values than those of patients without SAM.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Genesis of systolic anterior motion (SAM) of the mitral valve in patients with aortic regurgitation]. 281 36

Percutaneous transvenous mitral valvuloplasty (PTMV) using the Inoue balloon was performed in 18 patients with symptomatic mitral stenosis. They were seven men and 11 women, ranging in age from 38 to 77 years (mean 59 +/- 10 years). Among them, 13 were categorized as NYHA class II; four as class III; and one as class IV. As a result, the symptoms of 14 patients markedly improved. Survey by means of right and left heart catheterization and echocardiography before and after PTMV demonstrated significant improvement in test values; (1) a decrease in the mean mitral gradient from 8.5 +/- 3.3 to 4.8 +/- 2.0 mmHg (p less than 0.01), (2) an increase in the mean diastolic descent rate of the mitral valve from 17.6 +/- 8.3 to 25.1 +/- 8.1 mm/sec. (p less than 0.01), and (3) an increase in the mean mitral valve area from 1.3 +/- 0.5 to 1.7 +/- 0.5 cm2 (p less than 0.01). Bicycle ergometer stress test performed on the 13 patients before and after PTMV revealed a significant decrease in the mean pulmonary arterial pressure from 24 +/- 5 to 18 +/- 5 mmHg (p less than 0.01) at rest, and from 49 +/- 9 to 42 +/- 7 mmHg (p less than 0.05) after exercise. The degree of mitral regurgitation increased after PTMV in six patients, in three of whom it was severe. The severity was evidenced by a significant increase in the ratio of the mean balloon diameter to body surface area as compared with the data of the other 15 patients (20.6 +/- 2.2 to 18.0 +/- 1.4 mm/m2; p less than 0.05), the presence of a localized sclerosis of the mitral valve as demonstrated by two-dimensional echocardiography, and prolapse of the mitral valve as shown by a left atriogram. These early results indicated that PTMV using the Inoue balloon is an effective treatment for symptomatic patients with mitral stenosis unless severe mitral regurgitation develops. This complication may be partially due to the selection of an inappropriate balloon diameter, and due to co-existing myxomatous degeneration and localized sclerotic changes of the mitral valve.
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PMID:[Percutaneous transvenous mitral valvuloplasty: short-term effects and complications]. 281 40

From 1984 to 1988, 129 mitral valve reconstructions were done for primary pure mitral regurgitation. Sixty-two (48%) were done for myxomatous degeneration and prolapse of the mitral valve. Anterior leaflet resection was performed in seven patients, posterior leaflet resection in 46, anteroposterior resection in four; five patients received only a ring annuloplasty. Eight patients had coronary bypass grafts. Twenty-four patients received a Carpentier-Edwards annuloplasty ring, 24 a Duran ring, and 14 patients had no ring. Follow-up was 1 to 50 months (mean, 13 months). No patient was lost to follow-up. There was one operative death from gastrointestinal bleeding and two late deaths (one from suicide and one from a myocardial infarction), and the probability of survival at 48 months was 84% +/- 15%. There were no thromboembolic episodes or episodes of endocarditis. However, there were five reoperations (9%) with freedom from reoperation at 48 months of 85% +/- 5%. There was one major anticoagulant hemorrhage. Freedom from all morbidity at 48 months was 81% +/- 8%. Postoperative echocardiographic data in the three different groups of patients undergoing repair on the basis of annuloplasty treatment showed that the peak gradient was less and the valve area was slightly greater with no annuloplasty ring.
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PMID:Mitral valve repair for myxomatous degeneration and prolapse of the mitral valve. 281 29

Since the mitral anulus is now known to be saddle-shaped, use of the qualitative motion of the mitral valve (MV) leaflets in the apical four-chamber plane to diagnose mitral valve prolapse (MVP) may be unsound, in that superior systolic displacement of the MV leaflets would occur in normal subjects, as well as in patients with MVP. It has therefore been suggested that the parasternal long axis (PLAX) plane should be used to diagnose MVP. To test the feasibility of this approach, the authors examined the predictive accuracy of PLAX prolapse and other isolated echocardiographic abnormalities versus a multivariate decision tree approach. PLAX prolapse, which was significantly associated with marked (greater than 0.7 cm) apical four-chamber prolapse, mitral regurgitation, the presence of a thick mitral valve, and low relative body weight, was 100% specific for MVP but only 44% sensitive. Similarly, marked apical four-chamber prolapse was 100% specific but only 53% sensitive. Apical four-chamber prolapse, if gauged only qualitatively as present or absent, was 94% sensitive but only 50% specific. By contrast, the decision tree classified all 32 initial patients correctly, and in a second, test set, selected 6 additional patients; these 6 patients had many of the clinical features of MVP. These observations suggest that: (1) if prolapse is seen in the PLAX plane, the patient does have MVP; on the other hand, lack of prolapse in this plane does not exclude the diagnosis of MVP and (2) the apical four-chamber plane, used qualitatively, does not reliably distinguish patients with MVP from those without MVP.
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PMID:Can the parasternal long axis plane replace the apical four-chamber plane in diagnosing mitral valve prolapse? 291 59

Mitral-valve prolapse is a common cardiac valvular disorder with a wide range of severity and diverse clinical outcomes. The lack of a standard definition of mitral-valve prolapse may explain the variation in reported complication rates. To identify high-risk and low-risk subgroups, we retrospectively analyzed clinical and two-dimensional echocardiographic data from 456 patients with mitral-valve prolapse. Mitral-valve prolapse was defined on the basis of echocardiographic findings as systolic displacement into the left atrium of one or both leaflets beyond the plane of the mitral annulus in the parasternal long-axis view. Two groups of patients were compared: those with thickening of the mitral-valve leaflets and redundancy (designated the classic form; n = 319) and those without leaflet thickening (designated the nonclassic form; n = 137). The two groups were similar in age and sex ratio. Complications or a history of complications was more prevalent in the classic than the nonclassic form: infective endocarditis, 3.5 percent and 0 percent, respectively (P less than 0.02); moderate-to-severe mitral regurgitation, 12 percent and 0 percent (P less than 0.001); and the need for mitral-valve replacement, 6.6 percent and 0.7 percent (P less than 0.02). However, the frequency of stroke was similar in the two groups: 7.5 percent and 5.8 percent (P not significant). We conclude that in a selected population of patients with mitral-valve prolapse, those with the classic form (leaflet thickening and redundancy) are at higher risk than those without these features for the infectious and hemodynamic complications of mitral-valve prolapse, but not for stroke.
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PMID:Identification of high-risk and low-risk subgroups of patients with mitral-valve prolapse. 292 82

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