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

We report a 52 year old man, who without previous thoracic trauma, cardiac diseases or cardiovascular risk factors presented after mild epigastric discomfort acute pulmonary oedema. He did not present clinical, electrocardiographic and biochemical manifestation of acute myocardial infarction. He was hospitalized and 15 days later he was sent to our hospital intubated and with assisted respiration. Haemodynamic studies showed severe acute mitral regurgitation and absence of significant obstructing lesions in the coronaries arteries. He was operated few hours after admission. The surgeon found a dysplasic mitral valve and rupture of a head of the posteromedial papillary muscle. The anatomopathological studies discovered mitral myxoid degeneration and ischemic lesion of the papillary muscle. We review the literature of the exclusive infarction of the papillary muscles and their possible relationships with the mitral prolapse syndrome.
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PMID:[Rupture of the mitral posteromedial papillary muscle associated with myxomatous mitral valve]. 262 3

A 40-year-old man was admitted to our hospital in May 1982 for evaluation of a heart murmur. A standard 12-lead electrocardiogram (ECG) showed an abnormal Q wave in lead III. Echocardiography revealed prolapse of the anterior mitral valve leaflet (MVP), but neither dilatation nor wall motion abnormalities of the left ventricle (LV) were observed. Thallium-201 scintigraphy revealed an abnormal thallium uptake at the apex and inferior wall. He had no episode of acute myocardial infarction or myocarditis, but complete right bundle branch block suddenly appeared, and he was hospitalized in October 1984. He had no coronary artery lesions, and only mild mitral regurgitation on left ventriculography. The motion of the interventricular septum and apex was reduced on echocardiography and a persistent perfusion defect was observed at the inferior wall and the interventricular septum on T1-201 scintigraphy. In December 1985, he experienced an Adams-Stokes attack due to complete atrioventricular block. Echocardiographically, the left ventricle became enlarged and the wall motion abnormality and a perfusion defect on T1-201 scintigrams were of relatively severe degree. Thus, left ventricular dilatation and wall motion abnormality may progress in some cases of MVP as it did in this one. We consider this case a very interesting one in speculating on the relationship between MVP and DCM.
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PMID:[Regression of mitral valve prolapse to a state masquerading as dilated cardiomyopathy: a case report]. 350 16

In emergency surgery, the essential prerequisites for success are speed, promptitude and precision. For this reason diagnosis must be equally prompt and precise and may require not only clinical examination but also a number of instrumental examinations designed to confirm or even to formulate the diagnosis which is usually the case in precordialgias of cardiovascular origin. In such syndromes ultrasound cardiography is particularly advantageous for the following reasons: it is non-invasive, provides immediate results and any number of examinations can be performed on the patient in bed. Since such ultrasound techniques are also reliably accurate, they constitute the method of choice when the patient's condition is critical, when a serial study of a single patient is required and when the results are required immediately, as is the case in emergency heart surgery. Four types of ultrasound cardiography are currently available for the diagnosis of precordialgias of cardiovascular origin: 1) one dimensional M-mode echocardiography; 2) two dimensional real time echocardiography; 3) Doppler ultrasound cardiography; 4) the echo-Doppler system in which Doppler ultrasound cardiography is combined with one or two dimensional echocardiography. Acute precordial pain of cardiovascular origin may be due to the following pathological conditions: 1) ischaemic cardiopathy especially acute myocardial infarction and transitory myocardial ischaemia; 2) acute pericarditis; 3) aortic stenosis; 4) idiopathic hypertrophic subaortic stenosis; 5) mitral prolapse; 6) dissecting aneurysm of the aorta; 7) pulmonary thromboembolism. In all these cases the single and two dimensional image and Doppler ultrasound cardiography provide highly sensitive and specific information that is, in some cases, decisive for diagnosis and in others confirms the diagnosis already formulated. In addition these techniques may provide valuable prognostic data. Ultrasound cardiography is indeed useful in all cardiological emergencies, such as those caused by cardiomegaly, new and developing murmurs, peripheral embolisms, cardiac traumas and arrhythmias. It is therefore suggested that every Emergency and Intensive Care Unit should be able to use the resources offered by ultrasound cardiography in diagnosis.
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PMID:[Emergency ultrasound cardiography in acute precordial pain of cardiovascular origin]. 362 31

Echocardiographic studies have recently documented high incidence of mitral valve prolapse in cases with papillary muscle dysfunction (PMD). However, any pathologic evidence has not been yet described. To evaluate the incidence and the degree of morphologic prolapse of the mitral valve, we examined 76 cases of mitral regurgitation which were pathologically proved to have PMD among 3,000 consecutive autopsy cases over 60 years of age. The morphologic evidence of "mitral valve prolapse" was defined as overshooting of the mitral leaflet into the left atrium beyond the degree of normal hooding. Papillary muscle dysfunction was classified into three types; Type A due to old myocardial infarction, Type B due to acute myocardial infarction, and Type C induced by other factors such as cardiomyopathies. The following results were obtained: Morphologic "mitral valve prolapse" was found in 19 among the 76 cases (25%) of PMD, but marked "prolapse" was found in only one case. The incidence of morphologic "prolapse" did not show any difference among the types of PMD (cf. Fig. 1). The site of "prolapse" was mainly in the region of posteromedial commissure of the mitral valve. Echocardiographic study of 39 cases with PMD showed mitral valve prolapse in only two cases who belonged to the eight cases having morphologic "mitral valve prolapse". This study suggests that prolapse formation of the mitral valve secondary to PMD can be differentiated morphologically from those following primary myxomatous degeneration of the mitral leaflets as observed in cases with MVP.
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PMID:[A study on prolapse of the mitral valve in autopsy-proved papillary muscle dysfunction]. 653 94

We report a case of mitral regurgitation caused by a total rupture of the posterior papillary muscle that had occurred after acute myocardial infarction. A 72-year-old woman was transferred to our hospital for cardiogenic shock. Echocardiogram revealed massive mitral regurgitation and prolapse of posterior mitral leaflet presumably due to a rupture of a papillary muscle. Cardiac catheterization demonstrated a total occlusion in the segment 2 of the right coronary artery. She had developed progressively increasing heart failure even though the patient had received a successful PTCA for a total occlusion of the right coronary artery. She underwent an emergency mitral valve replacement with preservation of the posterior leaflet using a SJM prosthetic valve. Intraoperative findings were confirmative of total rupture of the posterior papillary muscle. A postoperative course was uneventful. This case is the seventh case which has been reported as the successful operation of a total rupture of the papillary muscle in Japan.
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PMID:[A case of acute postinfarction mitral regurgitation and cardiogenic shock caused by a total rupture of the papillary muscle]. 847 86

Papillary muscle rupture is a rare but generally fatal mechanical complication of acute myocardial infarction. In contrast to complete papillary muscle rupture, echocardiographic recognition of partial papillary muscle rupture has rarely been reported and seems to be more challenging. We describe a patient with partial papillary muscle rupture that could only be diagnosed by multiplane transoesophageal echocardiography, whereas transthoracic echocardiography and single plane transesophageal echocardiography showed only posterior mitral leaflet prolapse.
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PMID:Partial papillary muscle rupture complicating acute myocardial infarction. diagnosis by multiplane transoesophageal echocardiography. 888 74

We report a 62-year-old man who developed coma and died in a fulminant course. The patient was well until May 1, 1996 when he noted chillness, tenderness in his shoulders, and he went to bed without having his lunch and dinner. In the early morning of May 2, his families found him unresponsive and snoring; he was brought into the ER of our hospital. He had histories of hypertension, gout, and hyperlipidemia since 42 years of the age. On admission, his blood pressure was 120/70, heart rate 102 and regular, and body temperature 36.3 degrees C. His respiration was regular and he was not cyanotic. Low pitch rhonchi was heard in his right lower lung field. Otherwise general physical examination was unremarkable. Neurologic examination revealed that he was somnolent and he was only able to respond to simple questions such as opening eyes and grasping the examiner's hand, but he was unable to respond verbally. The optic discs were flat; the right pupil was slightly larger than the left, but both reacted to light. He showed ptosis on the left side, conjugate deviation of eyes to the left, and right facial paresis. The oculocephalic response and the corneal reflex were present. His right extremities were paralyzed and did not respond to pain Deep tendon reflexes were exaggerated on the right side and the plantar response was extensor on the right. No meningeal signs were present. Laboratory examination revealed the following abnormalities; WBC 18,400/ml, GOT 131 IU/l GPT 50 IU/l, CK616 IU/l, BUN 30 mg/dl, Cr 2.1 mg/ dl, glucose 339 mg/dl, and CRP 27.4 mg/dl. ECG showed sinus tachycardia and ST elevation in II, III and a VF leads and abnormal q waves in I, V5, and V6 leads. Chest X-ray revealed cardiac enlargement but the lung fields were clear. Cranial CT scan revealed low density areas in the left middle cerebral and left posterior cerebral artery territories. The patient was treated with intravenous glycerol infusion and other supportive measures. At 2: 10 AM on May 3, he developed sudden hypotension and cardiopulmonary arrest. He was pronounced dead at 3:45 AM. The patient was discussed in a neurological CPC, and the chief discussant arrived at the conclusion that the patient had acute myocardial infarction involving the inferior and the true posterior walls and left internal carotid embolism from a mural thrombus. Post mortem examination revealed occlusion of the circumflex branch of the left coronary artery due to atherom plaque rupture and myocardial infarction involving the posterior and the lateral wall with a rupture in the postero-lateral wall. Marked atheromatous changes were seen in the left internal carotid, the middle cerebral and the basilar arteries; the left internal carotid and the middle cerebral arteries were almost occluded by thrombi and blood coagulate. The territories of the left middle cerebral and the occipital arteries were infarcted; but the left thalamic area was spared. The neuropathologist concluded that the infarction was thrombotic origin not an embolic one as the atherosclerotic changes were severe. Cardiac rupture appeared to be the cause of terminal sudden hypotension and cardiopulmonary arrest. It appears likely that a vegetation which had been attached to the aortic valve induced thromboembolic occlusion of the left internal carotid artery which had already been markedly sclerotic by atherosclerosis. It is also possible that the vegetations in the aortic valve came from mural thrombi at the site of acute myocardial infarction, as no bacteria were found in those vegetations.
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PMID:[A 62-year-old man with an acute onset of consciousness disturbances]. 945 48

Papillary muscle rupture is a rare but severe complication of acute myocardial infarction. Two cases successfully underwent mitral valve replacement and concomitant coronary artery bypass grafting (CABG) for acute myocardial infarction with the anterior papillary muscle rupture in cardiogenic shock. Each of them needed preoperative massive inotropic infusion, respiratory support and intraaortic balloon pumping assist. The first case was a 76-year-old female. Double vessel disease (seg 7 : 90%, seg 11 : 100%) was revealed by coronary angiography and rupture of the papillary muscle was confirmed by transesophageal echocardiography. The second case was a 69-year-old female. Double vessel disease (seg 2 : 90%, seg 11 : 100%) was revealed and severe mitral regurgitation due to prolapse of the anterior leaflet was confirmed by transthoracic echocardiography. To assess the diagnosis of postinfarction papillary muscle rupture, transthoracic and/or transesophageal echocardiography is mandatory. Coronary angiography is also desirable because concomitant myocardial revascularization may improve the prognosis.
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PMID:[Surgical management of papillary muscle rupture following acute myocardial infarction]. 1582 49

A 77-year-old female was admitted in our hospital for uterine prolapse surgery. She developed ventricular tachycardia during induction of general anaesthesia and after initial symptomatic measures, she was transferred to the coronary care unit. Heart failure persisted and electrocardiographic changes mimicking acute myocardial infarction appeared. Coronary angiography was normal and left ventriculography revealed akinesis of the apical region of the left ventricle and apical ballooning during systole, with relative sparing of the base of the heart. Complete recovery of left ventricular function occurred 8 days after the initial onset of symptoms. A diagnosis of Takotsubo syndrome was made on the basis of consistent clinical and laboratory findings, typical echocardiography and angiography findings, and reversible course. This case emphasises the importance of being aware of uncommon causes of cardiac dysfunction in stressful situations, especially during induction of general anaesthesia.
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PMID:Takotsubo syndrome during induction of general anaesthesia. 1769 32

A 32-year-old male was admitted with dyspnea Severe dyspnea and hypoxemia developed the next day and blood examination indicated acute myocardial infarction. Echocardiogram revealed massive mitral regurgitation with prolapse of the anterior mitral leaflet due to rupture in the papillary muscle. Percutaneous coronary intervention for total occlusion in the right coronary artery was successfully performed, but progressive heart failure continued to develop. Surgery for the papillary muscle rupture was performed on the 3rd day. Complete head rupture of the anterior papillary muscle was found and the mitral valve was replaced with a prosthetic valve (St. Jude Medical valve: #31). Pathological findings showed necrosis in the papillary muscle with inflammatory changes. The postoperative course was uneventful and the patient was discharged on the 43rd day after surgery.
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PMID:[Successful emergency surgery for acute mitral regurgitation due to total rupture in the anterior papillary muscle after acute myocardial infarction; report of a case]. 1853 1


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