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

The case of a 40-year-old woman with mitral valve prolapse and severe atypical chest pain is presented. The diagnosis was confirmed by phonocardiographic, echocardiographic, and angiocardiographic studies. The electrocardiogram revealed an ischemic pattern of ST-T on the anterior and inferior wall. Coronary angiographic studies showed normal coronary arteries. The patient's long-standing, prolonged, disabling atypical chest pain could not be relieved with medical therapy, despite the administration of beta-adrenergic blocking agents, calcium antagonists, and short-acting nitrites during a 30-month period. Thus, the prolapsed mitral valve was replaced with a Hancock xenograft. After 12 months the patient is totally free of symptoms, without any treatment and with a normal ECG. This excellent surgical result could be explained on the basis of the valvular theory of chest pain in mitral valve prolapse, suggesting that pain is promoted probably by a regional imbalance between oxygen availability and consumption, because of the excessive papillary muscular stretching produced by the prolapse. To our knowledge, this is the first published report of successful surgical treatment of chest pain in mitral valve prolapse.
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PMID:Surgical treatment for chest pain in mitral valve prolapse. 747 28

We describe the case of a 54-year-old male who was examined due to light chest pain experienced the previous day. The man was admitted to the cardiology division for the presence of a complete atrioventricular block. On admission the echocardiogram showed a large aortic regurgitation not present two years earlier. Suspecting an aortic dissection we performed a transesophageal echocardiography and a contrast computerized tomography: the two examinations were negative. The next days the patient had two episodes of acute pulmonary edema so he was transferred to the regional reference hospital where an hemodynamic unit and cardiac surgery division were available. There, he repeated a transesophageal echocardiography which was negative. The man had aortic valve replacement without angiography for his very critical condition. The surgeon identified a small aortic dissection, just above the aortic valve plane, which was responsible for valve leaflets prolapse and aortic regurgitation; the hematoma deepened towards the interatrial septum and atrioventricular junction justifying the atrioventricular block. In conclusion, a small aortic dissection can offer an atypical picture, and in this condition even very valuable diagnostic techniques may fail the diagnosis.
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PMID:[Total atrioventricular block as the primary clinical manifestation of undiagnosed aortic dissection]. 749 22

The authors report two cases of severe myocardial ischaemia with healthy coronary arteries associated with mitral valvular prolapse (MVP). The first case was a 43-year-old woman treated with beta-blockers following the discovery of MVP. This patient was admitted to hospital six months later with persistent chest pain in a context of cardiogenic shock. The response to treatment was rapid and spectacular. The second case was a 44-year-old hypertensive smoker man in whom assessment of chest pain revealed several signs of myocardial infarction as well as MVP. This rare combination of MVP and myocardial ischaemia raises pathophysiological as well as therapeutic problems.
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PMID:[Mitral valve prolapse and myocardial ischemia. Apropos of 2 cases]. 774 82

We describe a case of unsuspected infrahepatic interruption of the inferior vena cava with hemiazygos continuation in a 67-year-old man presenting with chest pain and evidence of mitral regurgitation. He had no persistent superior vena cava, with the hemiazygos draining directly into the right superior vena cava. Polysplenia and severe mitral prolapse were also present: the latter may represent more than an incidental finding in this condition. This malformation may deserve consideration in adults undergoing femoral right heart catheterization. Chest radiographic studies are the basic clue to the diagnosis.
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PMID:Unsuspected infrahepatic interruption of inferior vena cava associated with floppy mitral valve, mitral valve prolapse, and severe mitral regurgitation. 795 40

A 76-year-old female was admitted to our hospital due to anterior chest pain and dyspnea. Mitral regurgitation due to prolapse of the posterior leaflet was detected by UCG. After admission, massive gastric hemorrhage was observed. Because hemostatic therapy using endoscopy was not effective, partial gastrectomy was performed. The origin of the hemorrhage, an acute gastric ulcer, was located on the side of the minor curvature of the corpus ventriculi. After gastrectomy, the patient underwent medical treatment using an IABP, but the left heart failure was not reduced, and the pulmonary edema worsened. At 18 hours after gastrectomy, MVR was performed. The cause of regurgitation is torn chordae of the posterior leaflet. The postoperative course was good, and the patient is doing well in NYHA class 1. This case is the first report of acute mitral insufficiency associated with acute gastric lesion in Japan.
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PMID:[A case report of surgical treatment for acute mitral insufficiency associated with acute gastric lesion]. 875 97

The vertical reduction mammaplasty has been popularized over recent years. It always produces marked puckering of the excess skin and requires revision surgery for the persistent dog-ears that develop. Minor complications are often common. As a result, the evolution with S approach is developed. A series of 36 consecutive patients who underwent the S approach reduction mammaplasty is presented. The S approach can be described as having 1) superior dermoglandular pedicle, 2) simple and safe S-shaped skin marking, 3) suspension of the residual glandular tissues transversely to the periosteum of the 5th rib, and 4) short-scar closure. The surgical techniques are described in a step-by-step fashion. An analysis is made of the results obtained from these patients. The mean follow-up period of this study is 21 months. As a result of surgical operation, the symptoms of breast hypertrophy were markedly improved. According to patient assessment, neck, back, or chest pain decreased from 64% to 25%, shoulder grooving improved from 56% to 25%, stooped posture decreased from 42% to 14%, intetrigo improved from 36% to 8%, psychological embarrassment decreased from 33% to 8%. The postoperative complications included minimal areolar epidermolysis (11%), hypertrophic scar (8%), etc. All mammograms revealed hypertrophic patterns of the breast. The glandular tissues removed had a mean of 480 g from each breast. Two breasts (3%) had fibroadenomas. The sternal notch-nipple distance changed from a mean of 30.5 cm preoperatively to 20.5 cm, the length of infraareolar scar was 9 cm in average. Eighty-one percent of patients had minimal postoperative ptosis, and the sensitivity of nipple-areola complex was unchanged in 75% of patients. Nine patients (24%) retained the ability to lactate for more than 1 month postoperatively. Twenty-two patients (61%) were very satisfied with their operation, and eight (22%) were adequately satisfied. The technique presented is a simple and safe procedure that provides satisfactory results for patients with breast hypertrophy.
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PMID:Evolution of the vertical reduction mammaplasty: the S approach. 914 24

We successfully performed aortic root replacement for acute aortic dissection, Stanford type A involving the entire sinus of Valsalva, associated with acute anterior wall myocardial infarction and aortic valve insufficiency. A 57-year-old man was admitted complaining of chest pain. An emergency operation was performed after a perfusion catheter was inserted to 99% stenotic lesion of the left anterior descending artery (LAD) on the same day. The dissection extended to both ostia of the coronary arteries and disrupted all commissures of the aortic valve, resulting in severe prolapse of the aortic valve leaflets. Aortic root replacement was performed using a valved conduit. The left main coronary artery was reattached to the graft using interposition technique with a 8 mm diameter woven Dacron tube graft. In addition, the LAD and right coronary artery were bypassed using saphenous vein. The postoperative course was uneventful and the patient was discharged from hospital on the 35th postoperative day. Retaining no aortic sinus and adequate coronary artery reconstruction is important for surgical repair of aortic dissection involving the entire sinus portion of the ascending aorta.
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PMID:[A successful surgical case report of acute aortic dissection involving entire sinus of Valsalva]. 921 95

The authors studied the prevalence of mitral valve prolapse (MVP) in the group of 656 children and adolescents (329 males and 327 females), who were a representative sample (obtained with the Monte Carlo method of statistical trials) of all newborns in the city of Maribor, Republic of Slovenia, in the period of 18 years (1976-1992). The results were considered positive in children and adolescents who in addition to possible history (chest pain, palpitations, dizziness, loss of consciousness, headaches, perspiration), probable auscultatory finding (mezzosystolic click and late systolic murmur), and suspected phonocardiographic and ECG findings, also had a positive M-mode echocardiographic finding. The criteria for MVP on M-mode echocardiography were taken from the literature: descending of mitral cusp, either anterior or posterior, of at least 3 mm below the line connecting points C and D. Children and adolescents were divided into six age groups (infants, toddlers, preschool children, early school age, children in puberty, adolescents). Assuming MVP as a cause of cardiac arrhythmias, beside standard ECG we also performed holter ECG monitoring in 61 children and adolescents (29 with MVP, 32 without MVP). The results were tested with standard statistical tools (chi 2-test, Student t-test, 2 x 2 Fisher chi 2-test). MVP was found in 71 patients (10.8%, 32 males and 39 females). As regards age and sex we found lower prevalence of MVP in male children (9.7%) compared to female children (11.9%). The highest prevalence was found in early school age, more so in females (14.2 vs 13.7). The differences were not statistically significant (p > 0.05). In both sexes most frequent was endosystolic prolapse (males 59.3%, females 51.3%). Most commonly both cusps are involved in the prolapse (males 78.1%, females 66.7%). Most frequently measured descending of the cusps was 3-4.5 mm (males 56.2%, females 48.7%). Negative auscultatory finding (silent MVP) was detected in 47.8% of the patients with MVP. Most patients with diagnosed MVP had no symptoms (71.8%). The prevalence of asymptomatic MVP declines with age in both sexes. The prevalence of arrhythmias, both in standard ECG and holter ECG, is higher in patients with MVP (6.8:0%--NS and 44.6%:9.3%--p < 0.05). The influence of constitutional changes (dolichostenomelia, asthenic constitution, genua valga) on the appearance of MVP is reflected in statistically significant difference in the Rohr' index in the group of patients with MVP in relation to the healthy group (p < 0.05). The higher prevalence of headache and dizziness in the group with MVP is statistically significant (p < 0.05).
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PMID:[The mitral valve prolapse syndrome in children and adolescents]. 991 77

We describe an unusual case of transient resolution of preexisting mitral valve (MV) prolapse during acute cardiac dysfunction and the development of dynamic left ventricular (LV) outflow tract obstruction. The patient presented with lightheadedness, chest pain, and compromised hemodynamic status. Echocardiography revealed akinesis and deformation of the LV anterior wall and apex, hyperdynamic activity in the bases, anterior MV leaflet systolic anterior motion without prolapse, and a dynamic outflow tract gradient. Myocardial function fully recovered over 1 month. Repeat ultrasonography showed posterior MV leaflet prolapse and no anterior MV leaflet systolic anterior motion. Elongated MV leaflets may have contributed to dynamic outflow tract obstruction and life-threatening hemodynamic compromise during LV conformational change.
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PMID:Transformation of mitral valve prolapse to dynamic left ventricular outflow tract obstruction and back again in a patient with acute transient myocardial depression. 1075 51

A 52-year-old man came to the local emergency department with symptoms of heart failure and transient chest pain. Transthoracic echocardiography showed severe aortic regurgitation and a dilated ascending aorta. Aortic dissection was suspected, and he was transferred to our institution. Transesophageal echocardiography appeared to confirm the presence of a type A dissection. A mobile, linear structure was present in the proximal ascending aorta, suggesting the presence of dissection flap. Aortic cusp prolapse and severe aortic regurgitation were seen. At surgery, no aortic dissection was present. Rather, the commissure between right and left aortic valve cusps was separated from the wall of the aorta. Motion of the torn commissure with the cardiac cycle apparently led to the transesophageal echocardiographic appearance described. The ascending aorta was dilated. Histopathologic examination of the aorta confirmed the visual appearance of cystic medial necrosis. Aortic valve commissural tear is a rare event, which may lead to severe aortic regurgitation. This entity may lead to the false-positive transesophageal echocardiographic diagnosis of type A dissection.
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PMID:Aortic valve commissural tear mimicking type A aortic dissection. 1205 Jun 9


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