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

Although cardiac anomalies are well documented among children with Down's syndrome, data on the cardiac status of adults with Down's syndrome are sparse. Therefore, we performed cardiac auscultation and Doppler echocardiographic examinations in 35 asymptomatic adults with Down's syndrome. There were 25 men and ten women; their mean age (+/- SD) was 26 +/- 8 years. Only ten subjects (29%) had normal findings on examination. The most frequent abnormal findings were holosystolic mitral valve prolapse (MVP) in 20 subjects (57%) and mild aortic regurgitation in four subjects (11%). Of the 20 subjects with MVP, five had associated tricuspid valve prolapse, but none had notable mitral regurgitation. Thus, we found that the majority of asymptomatic adults with Down's syndrome had valvular heart abnormalities. The high frequency of MVP and aortic regurgitation suggests that these lesions may be specifically associated with Down's syndrome in adults.
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PMID:High frequency of mitral valve prolapse and aortic regurgitation among asymptomatic adults with Down's syndrome. 295 21

We compared color Doppler flow mapping data to angiographic data in 294 patients with suspected valvular regurgitation. Thirty-one patients had rheumatic mitral regurgitation and 37 had mitral regurgitation due to mitral valve prolapse by angiography. Ten patients had no angiographic regurgitation (4 rheumatic, 6 prolapse). The remaining patients included 86 with suspected aortic regurgitation and 130 with suspected tricuspid regurgitation. Angiographically 74 had aortic regurgitation and 111 tricuspid regurgitation. The maximum size of regurgitant jets was evaluated in each patient by color flow mapping. The width of the jets was also taken into consideration. In 29 of the 31 with rheumatic regurgitation and 67 of the 74 with aortic regurgitation by angiography, abnormal regurgitant signals were detected by color flow mapping. In both rheumatic mitral regurgitation and aortic regurgitation, color Doppler estimation of the jets correlated well with angiographic grading. The regurgitant jets in these regurgitation were not eccentric. In the 37 with mitral regurgitation in mitral valve prolapse by left ventriculography, abnormal jets were detected in 35 by color flow mapping. However, the regurgitant jets were eccentric and color Doppler estimation of the jets correlated poorly with angiographic grading. In patients with tricuspid regurgitation, color Doppler grading of regurgitation correlated poorly with right ventriculographic grading. A color Doppler underestimation was observed in 48%. In conclusion, color Doppler flow mapping is useful in the noninvasive detection and semiquantification of rheumatic mitral regurgitation and aortic regurgitation having non-eccentric jets, although this technique often underestimates the severity of regurgitation in mitral valve prolapse.
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PMID:Value and limitations of color Doppler flow mapping in the detection and semiquantification of valvular regurgitation. 296 Jul 51

The gross criteria for diagnosing prolapsing mitral valve are: 1. interchordal hooding of the involved leaflets, 2. hooding or doming of leaflets towards the left atrium, 3. elongation of the involved leaflets resulting in an increase in valve area, 4. dilatation of the valve annulus in patients with severe mitral regurgitation. The posterior leaflet is most frequently affected. The involved leaflets, in general, are thickened, soft, greyish white and have a smooth atrial surface. Chordae tendineae are described as elongated, tortuous and attenuated or thinned. Deviations from normal chordal insertion have recently been observed which possibly appear to represent the underlying abnormality. Microscopic findings include significant thickening of the spongiosa and the fibrosa, changes in dense collagen fibers in the atrialis layer, occasionally, with fibrin platelet deposits. Histochemical characterization of changes in the spongiosa may also be helpful in the diagnosis. Ultrastructurally, there may be changes in collagen and elastic fibers as well as myxoid areas. On comparison of findings in surgically-removed mitral valves with those of control specimens from autopsy patients with no cardiac abnormalities, the length of the anterior and posterior leaflet as well as the annular ring diameter was larger in the valves with prolapse. Two-dimensional echocardiography accurately assessed leaflet length when compared to morphologic measurements, however, the annular diameter during systole or diastole was smaller. In patients with mitral regurgitation requiring surgery, mitral valve prolapse is the most common cause. Annular ring dilatation and chordae tendineae rupture appear to contribute substantially to incurrence of the mitral regurgitation. The heart weight is increased in the majority of patients with symptomatic mitral valve prolapse but normal, however, in those without symptoms. The most frequent complication of mitral valve prolapse is mitral regurgitation with or without congestive heart failure. Patients with redundant leaflets may be at high risk of sudden death. Young women with abnormal resting ECG, prolonged Q-T interval, family history of sudden death or complex ventricular arrhythmias may also be at a greater risk of sudden death. The incidence of infective endocarditis appears higher in those with redundant than in those with nonredundant valves. The incidence of cerebral ischemic events is low.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The pathology of mitral valve prolapse. 304 84

The syndrome of primary mitral leaflet billow, with or without prolapse, is associated with myxomatous degeneration of the mitral valve apparatus, mainly the posterior leaflet, and the syndrome may be familial. It manifests clinically with an isolated nonejection systolic click (billow), a murmur of mitral regurgitation that is usually late systolic (prolapse), or a combination of murmur and click. Echocardiography identifies and assesses the extent of the billowing of mitral leaflet bodies but there are no specific echocardiographic criteria that can differentiate normal from pathological billowing. Similarly, a prolapsed leaflet is not detected echocardiographically when there is localized and mild failure of leaflet edge apposition but a more severely prolapsed, or flail, leaflet can be demonstrated and confirmed by that technique. Symptoms of the syndrome include anxiety, chest pain and palpitations. The resting electrocardiogram may show ST segment and T wave abnormalities. The majority of patients have a benign course and require reassurance only. Complications include systemic emboli, infective endocarditis, progression to severe mitral regurgitation, arrhythmias and, rarely, sudden death. Patients with prolapse of a leaflet edge are more likely to develop complications than those with only billowing of the leaflet bodies. Surgery, preferably valvuloplasty, is required for severe regurgitation and may also be indicated for potentially lethal tachyarrhythmias unresponsive to medical therapy. Mitral leaflet billow and prolapse may be secondary to, or associated with, many conditions. The prognosis is then principally that of the underlying disease of which ischemic heart disease and hypertrophic cardiomyopathy are the most important.
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PMID:Mitral valve billowing and prolapse: perspective at 25 years. 304 85

The discrepancies reported in various studies with respect to long-term prognosis in mitral valve prolapse can be attributed to the criteria employed for diagnosis and to the differing patient populations studied. Furthermore, mitral valve prolapse is not a single, well-defined disease but reflects rather a broad spectrum of a disease process. Echocardiographically, patients can be identified with redundant, thickened leaflets with excessive mitral valve motion and prolapse as well as those with normal appearing leaflets but systolic prolapse representative of differing disease processes with differing prognosis. The incidence of sudden cardiac death is estimated at a low value of 1.9/10,000 patients per year. In the presence of a normal resting ECG, with no hemodynamically-meaningful mitral regurgitation and no evidence of redundant mitral leaflets the risk is even less. Cerebral embolic events occur with an estimated incidence of 1/6000 patients per year, similarly low; it can be assumed that patients with very myxomatous, redundant mitral leaflets have the highest risk. The incidence of infective endocarditis is also low, estimated at 1/5725 patients per year (0.175%). Risk factors for complications include: a systolic murmur, advanced age, male sex and leaflet redundancy. The most important complication is mitral regurgitation for which the incidence is highest in older men and in the presence of left ventricular, dilatation.
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PMID:Follow-up observations in patients with mitral valve prolapse. 305 85

The aim of this study was to assess the diagnostic value of pulsed and continuous wave Doppler in mitral regurgitation. One hundred and twenty-one patients (64 women and 57 men aged 13 to 76 years, average 54 years) investigated for mitral regurgitation or ischaemic heart disease underwent left ventricular angiography and continuous wave and pulsed Doppler echocardiography. In addition to clinical examination, they also underwent M mode, 2D echocardiography and phonocardiography. They were divided into two groups according to the presence or absence of mitral regurgitation on angiography, chosen as the reference method. Group I comprised 51 patients with angiographic regurgitation, and Group II 70 patients without mitral regurgitation. The sensitivity of the Doppler examination was 98%. Of the 51 patients in Group I there was only one false negative in a patient with doubtful angiographic regurgitation in the context of an endocardial cushion defect. In comparison, the sensitivity of clinical examination and phonocardiography were 74.5% and 80% respectively; 13 cases of mitral regurgitation on angiography and Doppler echocardiography had no auscultatory signs. The specificity of the Doppler examination was 92.8%; 5 of the 70 patients in Group II had unquestionable systolic turbulence in the left atrium and 2D echocardiography showed the possible mechanism of these valvular leaks in 3 cases: 1 bivalvular prolapse, 1 rheumatic valvular thickening and 1 papillary muscle dysfunction. We interpret these 5 cases as being true mitral regurgitation but intermittent or too slight to be visible on angiography. The positive predictive value of systolic turbulence in the left was 90.9% and the negative predictive value was 98.4%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Pulsed and continuous Doppler in qualitative and quantitative diagnosis of mitral insufficiency]. 309 Sep 65

Seven patients aged 8 to 62 years with massive mitral regurgitation due to anterior leaflet prolapse related to rupture or elongation of the chordae tendinae underwent reconstructive mitral valvuloplasty between June 1984 and September 1985, consisting in transposition of a bandlet of the posterior leaflet and its chordae to the free edge of the anterior leaflet. Medium term results with 2 to 16 months follow-up (average 8 months) showed all patients to have returned to Class I of the NYHA Classification; 5 patients had no systolic murmur, a mild systolic murmur 1 and 2/6 was present in 2 cases. The quality of the repair was confirmed by pulsed Doppler examination in all patients and by catheterisation and angiography in 3 cases. This surgical technique offers a good solution to the problem of mitral regurgitation due to severe prolapse of the anterior leaflet caused by rupture or elongation of the chordae tendinae.
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PMID:[Treatment of anterior mitral valve prolapse by partial transposition of the posterior leaflet. Apropos of 7 cases]. 309 46

Between March, 1969 and March, 1984, 89 children aged from 2 to 12 years (mean: 8.3 +/- 2.5 years) and presenting with mitral valve regurgitation underwent valvuloplasty by the Carpentier technique. The cause of the regurgitation was rheumatic fever in 84 cases (94 p. 100), bacterial endocarditis in 4 cases and Barlow's disease in 1 case. Mitral valve regurgitation was divided into 3 types, namely: type I, normal valve motion (5 cases), type II, valve prolapse (74 cases) and type III, restricted valve motion due to fibrosis of the leaflets or chordae (20 cases). The hospital mortality rate was 2.3 p. 100 (2 deaths). The cumulative follow-up was 546 patients/years, and the actuarial survival rate at 10 years was 89.96 +/- 8.5 p. 100. At 10 years the actuarial thromboembolic complication rate was 2 p. 100, or 0.3 +/- 0.2 p. 100 per patient year, and the actuarial valvuloplasty deterioration rate was 27 +/- 8.5 p. 100. The risk of re-operation was 2.2 +/- 0.6 p. 100 per patient year. At 10 years 78.4 +/- 7.2 p. 100 of the children were free of all re-operation, and 69 p. 100 had no complication. Thus, whenever possible (i.e. in 90 p. 100 of the cases, according to our experience) and considering the satisfactory long-term results, all children with acquired mitral valve regurgitation should undergo mitral valvuloplasty as first-line treatment.
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PMID:[Valvuloplasties for acquired mitral insufficiency in children (Carpentier's technic). Long-term results in 87 cases]. 312 87

Patients with mitral valve prolapse may, even in the absence of associated coronary artery disease or significant mitral regurgitation, have abnormality in exercise left ventricular function. The precise reason for this abnormality, which appears to be age and sex related, is not clear. Abnormal ejection fraction response to exercise cannot be predicted by the nature of symptoms, electrocardiographic changes, arrhythmias, or by extent and severity of mitral valve prolapse by echocardiography. Caution should therefore be exercised in diagnosing associated coronary artery disease based on the ejection fraction response to exercise per se or even on exercise-induced wall motion abnormality. Patients with prolapse, have reduced exercise tolerance, which has been ascribed to reduced left ventricular filling and smaller left ventricular end-diastolic volume in the upright position. Patients with mitral valve prolapse and associated coronary artery disease or significant mitral regurgitation often have, as expected, abnormal left ventricular function during exercise.
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PMID:Exercise left ventricular performance in patients with mitral valve prolapse. 316 78

Prolapse of the anterior leaflet of the mitral valve is the result of ruptured chordae, elongated chordae, or elongated or ruptured papillary muscle. Several techniques have been described for the correction of mitral valve insufficiency. However, when there is severe rupture of the chordae, the most widely accepted solution is valve replacement. We describe a technique for the creation of a neochorda with a strip of tissue from the anterior leaflet of the mitral valve. This technique was used in two patients with severe mitral valve regurgitation. Formation of a neochorda and placement of a Carpentier ring to remodel the anulus obviated the need for a valve replacement. Both patients had an uneventful recovery. Studies performed 3 and 4 months postoperatively showed competent and well-functioning valves. One patient required a valve replacement for acute mitral insufficiency 5 years later, but the other patient was doing well 3 years after the operation. Despite the limited experience, we believe this technique offers a reasonable alternative to valve replacement.
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PMID:A new technique for repair of mitral insufficiency caused by ruptured chordae of the anterior leaflet. 318 70


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