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

Nineteen patients with types I and III Ehlers-Danlos syndrome were hospitalized at our institution between 1973 and 1978. Chest roentgenogram, electrocardiogram, and echocardiogram were done; 11 patients underwent cardiac catheterization. Thirty-five cardiac or great vessel abnormalities were detected. Fifteen patients had nitral valve prolapse; six also had tricuspid valve prolapse. Dilatation of the aortic root or extasia of the sinuses of Valsalva, or both, occurred in six patients. Dilatation of the pulmonary artery and annulus caused pulmonary regurgitation in one patient. Congenital heart defects included bicuspid aortic valve (two), pulmonary valvular stenosis (one), ventricular septal defect (two), and an atrial septal defect (one). The apparent high prevalence of cardiovascular abnormalities in hospitalized patients with types I and III Ehlers-Danlos syndrome necessitates a careful cardiovascular evaluation. Conversely, Ehlers-Danlos syndrome types I and III should be excluded in patients with mitral or tricuspid valve prolapse, great vessel dilatation, and congenital heart defects.
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PMID:The spectrum of cardiac defects in the Ehlers-Danlos syndrome, types I and III. 735 21

The durability of mitral valve repaired with reconstructive techniques is variable. If the durability continues to be good, mitral valve repair may be the procedure of choice in many patients with mitral regurgitation. Between December 1970 and June 1993, 54 patients had mitral valve repair for non-rheumatic mitral regurgitation. There were 38 men and 16 women with a mean age of 46.8 (range 19-68) years. The pathology which required surgical treatment was torn chordae in 38 patients, elongation of the chordae in five, valve prolapse without elongation or rupture of the chordae in six, infective endocarditis in three, and annular dilatation in two. Forty-four patients had triangular or quadrangular resection of the mitral leaflet, and seven had annuloplasty alone. Choral reconstruction was performed on three patients. There were no operative deaths. Five patients (9%) died late after operation. The actuarial survival rate and the valve-related death-free rate at 10 years were 83.9% and 90.0%, respectively. Seven patients (13%) required reoperation. Freedom from reoperation at 10 years was 84.5%. Improper evaluation of residual regurgitation during operation and suture dehiscence were the principal causes of reoperation. It was concluded that mitral valve repair for non-rheumatic mitral regurgitation showed low operative mortality and stable long-term results. It is suggested that intraoperative transoesophageal colour Doppler echocardiography provides accurate assessment of mitral valve competence and may be helpful in reducing the need for reoperation.
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PMID:Long-term results of mitral valve repair for non-rheumatic mitral regurgitation. 758 92

Chordal replacement with expanded polytetrafluorethylene suture has become a procedure of choice for repairing anterior leaflet prolapse among certain surgeons. However, most surgeons believe that the chordal replacement is too complicated and not reproducible. This report introduces a new method of chordal replacement using intraoperative epicardial and transesophageal echocardiography. Three dogs underwent the following procedures. One major marginal chorda of an anterior mitral leaflet was resected during cardiopulmonary bypass. A specially designed 3-0 polytetrafluoroethylene suture, having straight needles, was attached to the anterior leaflet by a mattress suture. Then the needles were brought from the root of the anterior papillary muscle to the outside of the left ventricle. After the bypass flow was reduced, both ends of the polytetrafluoroethylene suture were pulled under echocardiographic guidance until valve competence was achieved. At that point, the suture was temporarily tied. When cardiopulmonary bypass was discontinued, competence was again confirmed and the suture was tied permanently. When the procedures were completed, echocardiography showed trivial regurgitation and good pliability of the anterior leaflets in all animals. Left atrial pressures were sufficiently decreased. It appears that this new technique is reproducible for all surgeons because the optimal length of polytetrafluoroethylene chordae is determined with the valve functioning.
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PMID:New surgical method of chordal replacement for mitral valve incompetence with echocardiographic guidance. An experimental study. 793 8

A 56-year-old woman was admitted to our department because of congestive heart failure. Chest X-ray showed dextrocardia with situs inversus. The echocardiography revealed severe mitral regurgitation due to prolapse of posterior leaflet and secondary Venography demonstrated the bilateral superior vena cava, huge coronary sinus and hemiazygos continuation with hypoplastic inferior vena cava. Mitral valve regurgitation was repaired by Carpentier's and Burr's technique, and tricuspid valve regurgitation was repaired by Kay's technique. Her postoperative course was uneventful. Valve surgery for acquired valvular lesion in dextrocardia with situs inversus is rare. Although valve repair is easily performed even in mirror-image heart as well as in normal, levo-position heart, preoperative evaluation of systemic venous return is important in the case of dextrocardia with systemic venous anomalies.
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PMID:[An experience of successful valve repair for acquired mitral and tricuspid regurgitation in dextrocardia, situs inversus, bilateral vena cava, and hemiazygos continuation]. 799 Feb 78

The respective values of transoesophageal (TOE) and transthoracic echocardiography (TTE) in the evaluation of the mechanism and the quantification of pathological regurgitation of bioprosthetic heart valves were analysed in 23 patients (14 mitral, 9 aortic; duration of implantation 108 +/- 43.2 months). Surgical or pathological correlations were available in all cases and catheter data in 18 of the 23 patients. With regards to mitral bioprostheses, the TOE evaluations of the mechanism and site of regurgitation corresponded in all cases with the operative or pathological findings and quantification of mitral regurgitation concorded with angiography. There was an underestimation of the severity of mitral regurgitation in 30% of cases by TTE compared with angiography; prolapse was diagnosed in 7 of the 10 cases with cusp tears. It was not possible to accurately determine the intra or perivalvular site of regurgitation by TEE. With regards to aortic bioprostheses, TOE and TTE were equally useful in determining the mechanism of regurgitation, showing cusp prolapse in 6 of the 9 cases with cusp tears. However, TTE quantified regurgitation accurately in all cases with respect to angiography, whereas TOE was only contributive in 50% of cases. These results show that single plane TOE is superior to TTE in the quantification and determination of the mechanism of regurgitation in mitral bioprostheses, but that TTE remains better for the quantification of regurgitation of aortic bioprostheses.
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PMID:[Contribution of transesophageal and transthoracic echography in the evaluation of the mechanism and quantification of regurgitation in mitral and aortic bioprosthetic valves]. 812 52

Short- and long-term results of valve repair for degenerative mitral insufficiency are reported in 127 consecutive patients with a mean age of 57 years (range 25-76). Preoperatively, 32 patients (25%) were in NYHA functional class IV, 65 (51%) in class III, 29 (23%) in class II, and 1 (0.8%) in class I. The mitral lesions and the mechanism of valvular regurgitation were assessed preoperatively by echocardiography (transthoracic and/or transesophageal) and intraoperatively by inspection of the valvular structures. Cardiac catheterization was performed only in 14 patients with some evidence of concomitant coronary artery disease, and critical stenoses were found in 5 cases. The mitral valve prolapse was posterior in 66 cases (52%), anterior in 29 (23%) and of both leaflets in 32 (25%). The posterior prolapse was corrected by quadrangular resection technique. The anterior and both leaflet prolapses were managed by transposition of chordae from the mural leaflet to the prolapsed part of the anterior leaflet. To give more stability to the repair in all cases except one, the valve repair was completed by posterior annuloplasty, using a PTFE 4 mm conduit (73 pts) or an autologous pericardium graft (53 pts). One patient died perioperatively (operative mortality 0.7%) and in only one case (the one in which posterior annuloplasty was not performed) was mitral valve replacement necessary two days after operation, for dehiscence of the valvar reconstruction.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Technical evolution in the reparative surgery of degenerative mitral insufficiency]. 816

Twenty-two patients (mean age of 12.9 years) with ventricular septal defect (VSD) associated with aortic regurgitation (AR) were treated surgically. Sixteen patients had subpulmonic VSD and six had infracristal VSD. Fourteen patients with subpulmonic VSD underwent VSD closure alone. VSD was closed by pulling up the inferior rim to the pulmonary valve thus support the prolapse aortic cusp. AR improved in two and has remained stable in eleven for 0.5 to 12.7 years (mean 4.4 years). Aortic valve replacement (AVR) was necessary in an adult patient later. Plication of the aortic valve was effective in a young patient but ineffective in an adult patient. In infracristal VSD, AVR was necessary in two adult patients. In a young patient, AR improved by plication. Direct VSD closure ceased progression of AR in three patients. The long-term follow-up shows that VSD closure with our technique has been sufficient to arrest progression of AR in subpulmonic VSD. Early closure of VSD should be emphasized to prevent aortic valve prolapse and regurgitation.
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PMID:[Surgery for ventricular septal defect with aortic regurgitation]. 823 Sep 24

True and significant ischemic mitral regurgitation affects on average 4% of the patients undergoing coronary bypass surgery. It not corrected, it profoundly influences the hospital mortality and the five year survival, even in the case of satisfactory myocardial revascularization. It is found predominantly in cases of right coronary and/or circumflex disease, and results mostly from restricted leaflet motion rather than from prolapse. Mitral annulus dilatation is present in all cases, and is the only mechanism of regurgitation in 50% of the patients. The indication for a valve procedure usually rests on findings at heart catheterization (i.e. the ratio of regurgitant/forward stroke volume, LV end-systolic volume index), but may be refined by pre- and perioperative transesophageal echocardiography; the LV volume loading test is very helpful in taking the decision in case of moderate or intermittent regurgitation. Mitral valve annuloplasty will easily and expeditiously correct or decrease the regurgitation in the majority of cases. If the mitral valve has to be replaced, the surgeon should always try to keep the papillary muscle-annulus continuity, at least posteriorly.
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PMID:Ischemic mitral regurgitation: when and how should it be corrected? 826 63

The authors reviewed retrospectively the results of transoesophageal and transthoracic echocardiography in 26 patients with prosthetic aortic valve dysfunction in order to study the value and limitations of monoplane transoesophageal echocardiography in this condition. Surgical data was available in 14 of these cases. The diagnosis of abscess of the aortic ring was made on 7 occasions by transoesophageal echocardiography and on 3 occasions by transthoracic echocardiography Bacterial vegetations were visualised in 5 cases by transoesophageal echocardiography and in 1 case by transthoracic echocardiography. The diagnosis of thrombosis was made in 1 case by transoesophageal echocardiography and missed by transthoracic echocardiography; fibrous pannus (n = 1) was not recognised on transoesophageal and transthoracic echocardiography. In the latter two conditions, transthoracic Doppler showed signs of obstruction. The diagnosis of a stenotic bioprosthesis due to fibrocalcific degeneration was made in 1 case by transoesophageal and in 1 case by transthoracic echocardiography. Prolapse of cusp was diagnosed in 6 cases by transthoracic echocardiography. An intraprosthetic valve leak was visualised in 7 cases by transoesophageal echocardiography and in 9 cases by transthoracic echocardiography; periprosthetic leaks were diagnosed in 9 cases by transoesophageal and in 12 cases by transthoracic echocardiography. These results indicate that transoesophageal echocardiography is a major advance in the diagnosis of abscess of the aortic ring, bacterial vegetations and prosthetic valve thrombosis. On the other hand, transthoracic echocardiography remains superior for the quantification or regurgitation and enables evaluation of transprosthetic gradients of obstructive prostheses with continuous mode Doppler. Therefore, the two methods are complementary.
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PMID:[Value and limits of single-plane transesophageal echocardiography in dysfunctions of aortic valve prosthesis]. 829 36

Reconstructive mitral valve operation is now the preferred technique for the surgical treatment of prolapse of the posterior leaflet due to degenerative disease. Systolic anterior motion of the mitral valve with left ventricular outflow tract obstruction has been observed after such repair, with an incidence ranging from 4.5% to 10%. In an attempt to reduce the incidence of this complication, Carpentier has devised a new technique: the sliding leaflet plasty of the posterior leaflet. We report on 48 patients who underwent this new procedure between July 1990 and July 1992. One patient died perioperatively (2.1%). All other patients were able to be discharged on the ninth postoperative day. All patients underwent M-mode, two-dimensional, and Doppler echocardiography before discharge. Forty-one patients (85%) had no evidence of postoperative regurgitation, whereas 7 patients (15%) showed mild mitral valve insufficiency. Left ventricular outflow tract obstruction due to systolic anterior motion of the mitral valve was never detected. We believe that this technique of mitral valve repair is safe and seems to be effective in achieving a decreased incidence of left ventricular outflow tract obstruction.
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PMID:Carpentier "sliding leaflet" technique for repair of the mitral valve: early results. 831


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