Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

From 1984 to 1988, 129 mitral valve reconstructions were done for primary pure mitral regurgitation. Sixty-two (48%) were done for myxomatous degeneration and prolapse of the mitral valve. Anterior leaflet resection was performed in seven patients, posterior leaflet resection in 46, anteroposterior resection in four; five patients received only a ring annuloplasty. Eight patients had coronary bypass grafts. Twenty-four patients received a Carpentier-Edwards annuloplasty ring, 24 a Duran ring, and 14 patients had no ring. Follow-up was 1 to 50 months (mean, 13 months). No patient was lost to follow-up. There was one operative death from gastrointestinal bleeding and two late deaths (one from suicide and one from a myocardial infarction), and the probability of survival at 48 months was 84% +/- 15%. There were no thromboembolic episodes or episodes of endocarditis. However, there were five reoperations (9%) with freedom from reoperation at 48 months of 85% +/- 5%. There was one major anticoagulant hemorrhage. Freedom from all morbidity at 48 months was 81% +/- 8%. Postoperative echocardiographic data in the three different groups of patients undergoing repair on the basis of annuloplasty treatment showed that the peak gradient was less and the valve area was slightly greater with no annuloplasty ring.
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PMID:Mitral valve repair for myxomatous degeneration and prolapse of the mitral valve. 281 29

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.
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PMID:Papillary fibroelastoma of the mitral valve. 807 4

The question of whether to repair or replace the mitral valve in the elderly remains unanswered. The purpose of our study is to describe our experience with mitral valve repair (MVR) using Carpentier's technique in patients 70 years and older. Fifty consecutive patients underwent MVR between 1984-1992. There were 30 female patients. All had 2 + or more mitral regurgitation (MR). The valve pathology included ischemic (n = 28), myxomatous (n = 7) and rheumatic (n = 6), leaflet prolapse (n = 11) and healed bacterial endocarditis (n = 3). The clinical findings included: myocardial infarction (n = 17), congestive heart failure (n = 18), atrial fibrillation (n = 14) and pulmonary hypertension (n = 10). The surgical technique involved placement of a Carpentier ring (n = 41) or Duran ring (n = 3), resection of leaflets (n = 9), shortening of the chordae (n = 8) and commissurotomy (n = 6). At surgery, coronary bypass was carried out in 32 patients while the aortic valve was replaced in five and repaired in one. Postoperative complications included atrial fibrillation (n = 14), transient neurologic events (n = 4), heart block requiring pacemaker (n = 3) and prolonged intubation (n = 4). Echocardiogram carried out postoperatively showed 2 + MR in three patients, 1 + in four, and a trace or none in the remaining (n = 39). No patient required re-operation for MR. Three patients (6%) died within 30 days after surgery due to low output (n = 1), malignant ventricular arrhythmia (n = 1) and heart block with cardiac arrest (n = 1).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Mitral valve repair in patients over the age of 70 years. 808 76

From June 1981 to August 1992, 184 patients with mitral regurgitation due to degenerative disease underwent mitral valve repair. The mean age was 57 years, and 74% were men. One-third of the patients were in atrial fibrillation, and 71% were in New York Heart Association classes III and IV. The mitral regurgitation was due to prolapse of the posterior leaflet in 97 patients (53%), prolapse of the anterior leaflet in 42 (23%), and prolapse of both leaflets in 45 (24%). The degree of myxomatous changes was assessed intraoperatively as mild in 125 patients (68%), moderate in 27 (15%), and severe in 32 (17%). Mitral valve repair was accomplished largely by techniques described by Carpentier. Ring annuloplasty was performed in 160 patients (66 with Carpentier ring and 94 with Duran ring). There was one operative death, and 5 patients experienced life-threatening complications. Patients were followed up from 5 to 132 months (mean, 41 months). The actuarial survival at 8 years was 88% +/- 4%. The freedom from stroke at 8 years was 94% +/- 2%, and the freedom from transient ischemic attacks was 86% +/- 6%. Age greater than 60 years was the only factor associated with higher risk of thromboembolic complications by logistic regression analysis. The actuarial freedom from reoperation at 8 years was 95% +/- 2%. Advanced myxomatous changes in the leaflets of the mitral valve was the only significant factor associated with a higher risk of reoperation. Most patients were in New York Heart Association class I at the last follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Late results of mitral valve repair for mitral regurgitation due to degenerative disease. 832 79

Ninety consecutive patients underwent mitral valve repair for mitral regurgitation (MR) utilizing intraoperative transesophageal echocardiography (TEE). Fifty-nine males and 31 females between the ages of 31 and 88 with a mean age of 67.9 years were evaluated. Preoperative TEE demonstrated pathology involving the posterior leaflet in 28 patients, anterior leaflet in 21 patients, both leaflets in 19 patients, annular dilatation in 19 patients, and restricted leaflet in three patients. Surgical procedures attempted included quadrangle resection of posterior leaflet pathology (40), Duran "flip over" operation (13), or Goretex suture for anterior leaflet pathology (20), and ring alone for central/ischemic mitral regurgitation (20). TEE immediately following repair showed either no regurgitation or a trace in 78 patients (86%). Time elapsed since repair ranged from one month to 55 months, with a mean of 29 months. Long-range evaluation of mitral valve competence was done by clinical examination and transthoracic or transesophageal echocardiography. Three patients died postoperatively. Fifty-six of 87 patients (64%) had either no or trivial MR within the first year of follow-up. Ring alone for annular dilatation and Goretex suture for anterior leaflet prolapse had the highest incidence of progression of MR. Among the 65 patients followed over one year, 42 (64%) continue to have either none or trivial MR. Three patients had worsening MR requiring mitral valve replacement. Quadrangle resection for posterior leaflet repair and Duran "flip over" operation for anterior leaflet pathology had the highest success rate in long-term follow-up.
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PMID:Mitral valve repair for mitral regurgitation utilizing intraoperative transesophageal echocardiography--late results. 882 76

Ischaemic mitral regurgitation is an important determinant of survival in patients with coronary artery disease. A retrospective analysis was performed to evaluate the overall outcome and its determinants in patients with ischaemic mitral regurgitation. Over a period of 10 years, 72 patients underwent operations for mitral regurgitation of ischaemic origin. Age ranged from 37 to 68 years (mean 54.6 +/- 10.4 years), and 62 (86.1%) were male. Thirteen (18%) patients had acute and 59 (82%) had chronic ischaemic mitral regurgitation. Twenty-one patients were in New York Heart Association class II, 32 in class III and 19 in class IV. Moderate to severe left ventricular dysfunction was present in 42 patients. Valve prolapse was present in 35 (48.6%) patients and restricted leaflet motion secondary to myocardial dysfunction was present in 37 (51.4%) patients. All the patients were operated using standard cardiopulmonary bypass technique. Mitral valve was replaced in 33 patients and repaired in 39. Repair included a combination of techniques: chordal transposition (n = 2), chordal shortening (n = 18), leaflet resection (n = 2), posterior collar annuloplasty (n = 35) and annuloplasty with flexible Duran's ring (n = 3). Operative mortality was 18.1 percent (13/72). Low cardiac output was the cause of death in the majority (n = 10). Acute presentation and presence of restricted leaflet motion were the significant predictors of early mortality. Follow-up ranged from 3 to 84 months (mean 41.6 +/- 10.2 months). Late mortality was 46.2 percent. Actuarial survival in operative survivors at five years was 44.4 +/- 8.8 percent. To conclude, ischaemic mitral regurgitation carries a poor early and late outcome, with left ventricular dysfunction and presence of restricted leaflet motion being important contributors to it. In addition, acute presentation also reflects greater early mortality.
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PMID:Post-infarction ischaemic mitral regurgitation: what determines the outcome. 1072 41