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

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

Oculopharyngeal muscular dystrophy is a rare, autosomal dominant disorder which has been traced through 11 generations of a French Canadian family. The classic presenting complaints are palpebral ptosis and oropharyngeal dysphagia. The dysphagia is usually progressive and leads to repetitive regurgitation, increased alimentation time, and weight loss. Immunologic studies generally reveal elevated levels of IgA and IgG, while manometry demonstrates poor pharyngeal contraction. The dysphagia is frequently relieved by cricopharyngeal myotomy. We present two case reports and also a new ultrastructural finding of abnormal metallic mitochondrial inclusions. This finding has not been previously described in this disorder.
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PMID:Oculopharyngeal muscular dystrophy: recent ultrastructural evidence for mitochondrial abnormalities. 300

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 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

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

The clinical presentation, diagnosis, and surgical treatment of 63 patients with doubly committed subarterial ventricular septal defects (DCVSD) were analyzed retrospectively. The patients were divided into three groups. Thirty-one patients had severe congestive heart failure in infancy and presently have a large ventricular septal defect that has no tendency to close or to produce aortic valve regurgitation (Group 1). Ideally, these defects should be closed in infancy, and the transpulmonary approach is recommended to achieve closure. In the first group, there was one death in a patient with a hypoplastic right ventricle. In Group 2, nineteen patients had aortic valve prolapse or aortic valve regurgitation. The DCVSD were moderately large or small. A number of DCVSD in Group 2 patients had maintained the normal offsetting of the arterial valves. These defects must be closed by the time mild aortic valve regurgitation has occurred. In Group 2, there was one late death in a patient who developed subacute bacterial endocarditis. The two patients who had severe aortic valve regurgitation required aortic valve replacement and underwent multiple surgical procedures to replace calcified bioprostheses. Group 3 comprised 13 patients who were diagnosed with tetralogy of Fallot. All of these patients had a large DCVSD with aortic valve overriding. All Group 3 patients survived radical repair of the defect, which required a transannular patch in most cases (76%).
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PMID:Surgical management of doubly committed subarterial ventricular septal defects. 318 Apr 5

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

Surgically treated ventricular septal defect (VSD) was of supracristal type in 120 of 389 Chinese patients; 93 of the 120 were younger than 15 years. Concomitant aortic anomalies were present in 58 of the patients (regurgitation in 23 and cusp prolapse in 35). Corresponding figures among the 93 patients of the under-15 group were 40 (9 + 31). Direct suture or patch closure of the supracristal VSD and replacement or plication of anomalous aortic valves were the methods used. The results of direct closure were equal to those of patch closure. One patient died of subacute bacterial endocarditis, which had been present preoperatively. There were no other deaths. The postoperative observation period was 6 months to 7 years. As the incidence of associated valvulopathy increases with patient age, early operation for supracristal VSD, regardless of shunt volume, is advocated.
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PMID:Surgical treatment of supracristal type of ventricular septal defect. 322 24

Between January 1986 and November 1987, 31 patients (pt.) underwent reconstructive surgery for mitral regurgitation secondary to floppy valve. Six pt. were in NYHA functional class IV, 22 in III class and 3 in II class. The mitral valve prolapse was posterior in 20 cases, anterior in 7 cases and bilateral in 4 cases. Chordal rupture was present in 18 pt. The mitral valve was repaired by quadrangular excision of the mural leaflet and posterior annuloplasty performed by insertion of polytetrafluoroethylene graft. The anterior prolapse was managed by transposition of chordae from the mural leaflet to the prolapsed part of the anterior leaflet (11 cases). One patient died perioperatively from myocardial infarction. Subsequent follow-up (length: 12.1 +/- 4.9 months) revealed good functional and clinical results: all pt. were alive, in NYHA class I or II (3 pt.). Echocardiographic studies revealed a decrease in diastolic (3.68 +/- 0.6 vs. 3.17 +/- 0.3 cm/m2) and systolic (2.4 +/- 0.5 vs. 2.15 +/- 0.4 cm/m2) diameter. The shortening fraction did not decline significantly. The mitral area fell from 6.0 +/- 2.0 cm2 to 3.1 +/- 1.1 cm2. A moderate residual regurgitation was present in two pt. and a severe regurgitation was found in only one pt. Our experience suggests that valve repair may be considered the most suitable type of operation for mitral regurgitation secondary to floppy valve.
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PMID:[Mitral insufficiency caused by floppy valve: results of conservative surgical treatment]. 324 97

The present study clarified the clinical significance of the suction signal--regurgitant signal near the mitral valve in the left ventricle--as obtained by two-dimensional color Doppler echocardiography in patients with mitral regurgitation. The study population consisted of 39 patients with various heart diseases having mitral regurgitation. The presence of a mitral regurgitant signal was determined not only in the left atrium but in the left ventricle using the long-axis view, four-chamber view, and short-axis view. 1. The suction signal was observed in 17 cases; on the posteromedial commissure side in four; the central portion in seven; the anterolateral commissure side in five and the mitral aneurysm portion in one. The site of the suction signal indicated the mitral regurgitant orifice and was useful for identifying the regurgitant orifice particularly in cases with prolapse of the commissural scallop. 2. Left ventriculography was performed in 18 cases and the severity of mitral regurgitation was grade III/IV or IV/IV in seven of eight cases with suction signals and was grade II/IV in the remaining one, while it was grade II/IV or I/IV in all ten cases without the signal. Sensitivity was then 100% and specificity was 91% in diagnosing III/IV or greater regurgitation according to the presence of the suction signal. The left atrial jet distance, width and area in the 17 cases with suction signals were significantly greater than those of 22 cases without the signal (3.3 +/- 1.0 vs 1.9 +/- 0.7 cm, 1.4 +/- 0.7 vs 0.8 +/- 0.4 cm, and 4.2 +/- 2.8 vs 1.3 +/- 1.3 cm2, respectively). Thus, the suction signal in the left ventricle in mitral regurgitation provided useful information concerning not only the identification of a regurgitant orifice, but the grade of mitral regurgitation, as well.
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PMID:[The suction signal detected by color Doppler echocardiography in patients with mitral regurgitation: its clinical significance]. 324 87


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