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Query: UMLS:C0033377 (prolapse)
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Between August, 1969 and May 1978, 679 patients underwent homograft replacement of the aortic valve. Isolated elective valve replacement was performed in 411 patients. Thirty-four patients had total aortic root replacement with reimplantation of the coronary arteries. There were 16 early deaths (3.9%) and 43 late deaths (10.5%) during a follow-up between 3 and 102 months (mean 47 months). Actuarial analysis showed 87% survival at 5 years and 81% at 8 years. Valve failure occurred in 24 patients (5.9%) owing to prolapse of one cusp in eight patients (2.0%), infective endocarditis in seven patients (1.7%), and degeneration of the valve in nine patients (2.2%). Degenerative valve failure was encountered after the fourth year with an incidence of 4.8% of patients at risk and occurred only in grafts from donors over the age of 65 years. Diastolic murmurs were present in 28% of patients followed beyond 1 month and increased very slightly with time. Systemic embolism was not recorded in any patient despite the fact that anticoagulants were not used. The clinical results were judged to be good or excellent in 89% of patients. It is concluded that homograft replacement of the aortic valve gives satisfactory results with a low incidence of late valve failure.
J Thorac Cardiovasc Surg 1980 Jun
PMID:The use of "fresh" unstented homograft valves for replacement of the aortic valve. Analysis of 8 years' experience. 737 9

Rotational coronary atherectomy is an effective treatment for calcified ostial lesions. We report a case of guidewire transection during rotational atherectomy of a right coronary artery ostial stenosis. Guide catheter dislodgement appeared to have caused prolapse and kinking of the guidewire. Advancement of the burr over the kinked wire resulted in transection. The wire fragment was retrieved successfully using an inflated fixed-wire balloon catheter. This report illustrates the importance of excellent coaxial guide catheter alignment with rotational atherectomy and suggests that operators be vigilant to possible damage to the radiolucent rotational atherectomy guidewire.
Cathet Cardiovasc Diagn 1995 Jul
PMID:Guidewire transection during rotational coronary atherectomy due to guide catheter dislodgement and wire kinking. 755 28

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.
Cardiovasc Surg 1995 Aug
PMID:Long-term results of mitral valve repair for non-rheumatic mitral regurgitation. 758 92

Between 1980 and 1993, 20 patients less than 1 year of age underwent operations for congenital mitral valve disease. Ten patients had congenital mitral incompetence and 10 had congenital mitral stenosis. Mean age was 6.6 +/- 3.4 months and mean weight was 5.6 +/- 1.5 kg. Atrioventricular canal defects, univentricular heart, class III/IV hypoplastic left heart syndrome, discordant atrioventricular and ventriculoarterial connections, and acquired mitral valve disease were excluded. Indications for operation were intractable heart failure or severe pulmonary hypertension, or both. Associated lesions, present in 90% of the patients, had been corrected by a previous operation in seven. In congenital mitral incompetence there was normal leaflet motion (n = 3), leaflet prolapse (n = 2), and restricted leaflet motion (n = 5). In congenital mitral stenosis anatomic abnormalities were parachute mitral valve (n = 4), typical mitral stenosis (n = 3), hammock mitral valve (n = 2), and supramitral ring (n = 1). Mitral valve repair was initially performed in 19 patients and valve replacement in one with hammock valve. Concurrent repair of associated lesions was performed in 12 patients. The operative mortality rate was zero. There were six early reoperations in five patients for mitral valve replacement (n = 4), a second repair (n = 1), and prosthetic valve thrombectomy (n = 1). One late death occurred 9 months after valve replacement. Late reoperations for mitral valve replacement (n = 2), aortic valve replacement (n = 1), mitral valve repair (n = 2), subaortic stenosis resection (n = 1), and second mitral valve replacement (n = 1) were performed in five patients. Actuarial freedom from reoperation is 58.0% +/- 11.3% (70% confidence limits 46.9% to 68.9%) at 7 years. After a mean follow-up of 67.6 +/- 42.8 months, 94% of living patients are in New York Heart Association class I. Doppler echocardiographic studies among the 13 patients with a native mitral valve show mitral incompetence of greater than moderate degree in one patient and no significant residual mitral stenosis. Overall, six patients have mitral prosthetic valves with a mean transprosthetic gradient of 6.2 +/- 3.7 mm Hg. These results show that surgical treatment for congenital mitral valve disease in the first year of life can be performed with low mortality. Valve repair is a realistic goal in about 70% of patients and possibly more with increased experience. Reoperation rate is still high and is related to complexity of mitral lesions and associated anomalies, but late functional results are encouraging.
J Thorac Cardiovasc Surg 1995 Jan
PMID:Surgery for congenital mitral valve disease in the first year of life. 781 93

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.
J Thorac Cardiovasc Surg 1994 Oct
PMID:New surgical method of chordal replacement for mitral valve incompetence with echocardiographic guidance. An experimental study. 793 8

A case report of a 73-year-old woman with mitral regurgitation secondary to papillary fibroelastoma and prolapse of the mitral valve is described. The tumor was excised, and the valve repaired with a Duran annuloplasty ring. The clinicopathologic features and the surgical management of this rare tumor are reviewed.
Cardiovasc Surg 1993 Oct
PMID:Papillary fibroelastoma of the mitral valve. 807 4

Between September 1980 and August 1988, 21 patients, of mean age 7.3 (range 1-19) years, with ventricular septal defect and aortic valve prolapse, underwent surgery. Aortic insufficiency was mild in three patients, moderate in 13 and severe in five. Surgical repair was performed using a combined transaortic and transpulmonary approach. The prolapsed leaflets were evaluated through the ventricular septal defect before and after valvuloplasty. Using the Trusler technique, the prolapsed cusps were plicated at the level of the commissures; only one patient required aortic valve replacement. After functional assessment of the valve repair, through the ventricular septal defect, during infusion of cardioplegia in the aortic root, the defects were closed through the pulmonary artery, or through a right atriotomy. Mean follow-up was 51.5 (range 3-108) months. One patient developed bacterial endocarditis and died 3 months after surgery. The other 20 patients remained symptom-free. There are no residual ventricular septal defects, and mild residual aortic insufficiency is present in six patients. The mean(s.d.) cardiothoracic ratio decreased from 0.61(0.07) before to 0.49(0.05) after surgery. In summary, preservation and repair of the prolapsed aortic valve is possible even in the presence of severe aortic insufficiency. The combined approach through both great arteries enables good visualization with minimal traction, and accurate assessment of the aortic valvuloplasty through the ventricular septal defect. In addition, problems associated with a right ventriculotomy are avoided.
Cardiovasc Surg 1993 Dec
PMID:Combined transaortic-transpulmonary approach for surgical repair of aortic insufficiency associated with ventricular septal defect. 807 11

Epidemiological studies in the United States indicate that 5% of the population or nearly 7 million people have Mitral Valve Prolapse. This incidence has also been confirmed by British physicians. Approximately half of these persons seek medical care for treatment of symptoms. Persons with symptoms are often said to have "Mitral Valve Prolapse Syndrome." The purpose of this study was to describe experiences and self-care needs of persons diagnosed with Mitral Valve Prolapse Syndrome (MVPS). In Phase I of the study, medical records of 124 subjects were reviewed to identify the medical experience and typical symptoms associated with MVPS. In Phase II, 20 subjects with typical symptoms were interviewed using a semi-structured questionnaire based on health deviation self-care requisites developed by Orem. Results of this pilot study indicate that interviewed subjects with MVPS frequently had unresolved health concerns and were seeking help. Nursing assistance may therefore be needed to help such clients understand this health deviation, to make decisions regarding appropriate actions, and to accomplish self-care actions.
Prog Cardiovasc Nurs 1993
PMID:Perspectives of the person with mitral valve prolapse syndrome: a study of self-care needs derived from a health deviation. 837 86

Endoluminal stenting has often become the percutaneous treatment of choice for older vein grafts. We report a case of successful stenting of a degenerated vein graft that was complicated by prolapse of atheroma through the stents leading to ischemia that was successfully reversed by catheter aspiration of the prolapsed atheroma.
Cathet Cardiovasc Diagn 1996 Nov
PMID:Transcatheter aspiration of atheroma prolapsing through saphenous vein graft stents. 893 68

It has been shown that the articulation site in the Palmaz-Schatz stent is a frequent site for restenosis. In this communication, we report on a new method to eliminate the articulation site in the Palmaz-Schatz stent to provide better lesion coverage and decrease the probability of plaque prolapse at the articulation site. We believe that this method is simple and effective, and that it serves an important clinical purpose.
Cathet Cardiovasc Diagn 1997 Feb
PMID:A method to eliminate articulation from the Palmaz-Schatz stent delivery system. 904 71


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