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Query: UMLS:C0033377 (prolapse)
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Auscultation was compared to two-dimensional echocardiography (2D echo) and Doppler ultrasonography in 140 consecutive patients referred for evaluation for suspected mitral valve prolapse (MVP) to asses the precision of the two diagnostic methods. Ninety patients (64%) had midsystolic clicks, of which 42 (47%) had MVP by echocardiography; 6 patients (4%) had MVP by 2D echo but no click on examination. In 15 (17%) of the 90 patients, a click was heard only in the standing or squatting positions and 2D echo did not detect prolapse in the supine position in 10 (67%) of the 15. With auscultation as the reference standard for MVP, 2D echo has a sensitivity of 47% and a specificity of 89%. Of the 140 patients, 51 (36%) had systolic murmurs; Doppler detected mitral and/or tricuspid regurgitation in 26 (50%). In 23 (16%) patients, there was Doppler evidence of mitral or tricuspid regurgitation even though systolic murmurs were not heard. Auscultation shows a 53% sensitivity and 73% specificity for systolic murmurs, using Doppler ultrasonography as the reference standard. Of 48 patients with MVP by 2D echo, 15 (13%) had associated mitral regurgitation by Doppler. The results indicate that 2D echo and Doppler ultrasonography should be interpreted in concert with auscultation for the diagnosis of mitral valve prolapse and for therapeutic decision making.
Clin Cardiol 1988 Jun
PMID:Comparison of auscultation with two-dimensional and Doppler echocardiography in patients with suspected mitral valve prolapse. 339 40

To clarify the mechanisms and time course of mitral regurgitation (MR) in mitral valve prolapse (MVP), the relationship between the timing of MR flow patterns on pulsed Doppler echocardiography and phase of mitral valve prolapse on two-dimensional echocardiography was investigated. 1. Thirty-seven patients with MVP were followed by pulsed Doppler echocardiography for one to six years with an average of 2.5 years. At the initial examination, the patients were classified in five subsets on the basis of the presence or timing of MR: 10 without MR, five with early systolic MR, one with mid-systolic MR, 15 with late systolic MR and six with pansystolic MR. During the follow-up period, the timing of MR did not change in 21 patients (three with no MR, five with early systolic MR, seven with late systolic MR and six with pansystolic MR). Various changes were observed in 16 patients, i.e., developments of late systolic MR from no MR in four, of pansystolic from no MR in three, from late systolic MR in five and from mid-systolic MR in one, and disappearing late systolic MR in three. 2. Mitral annular diameter and the prolapsing phase of 118 patients with MVP (44 without MR, eight with early systolic MR, 30 with late systolic MR and 36 with pansystolic MR) were examined by long-axis two-dimensional echocardiography. The mitral annular diameter in patients with early systolic MR was significantly less than that of other MR groups, and the diameter in patients with pansystolic MR was markedly increased. The timing of MR was determined according to the prolapsing phase and the grade of the prolapse and the systolic size of the mitral annulus. Six of the eight patients with early systolic MR first had early systolic prolapse of either mitral leaflet, and then the regurgitant gap of the mitral valve orifice was plugged by the prolapsing leaflet and/or the narrowed mitral annulus during mid-to-late systole. In 18 of the 30 patients with late systolic MR, the grade of prolapse of the mitral valve during mid-to-late systole was more severe, compared with that of early systole. The results of the present study indicated that the occurrence of MR in MVP is various in timing (early, mid-, late or pansystole) and shows various changes the during follow-up study, and that pulsed Doppler echocardiography allows phase analysis of MR in MVP.
J Cardiol 1987 Sep
PMID:[Mitral regurgitation in mitral valve prolapse: its mechanisms and time course]. 345 46

To study valvular lesions in the acute phase of Kawasaki disease, 17 patients who were admitted to our institution before the 12th day of their illness were examined using real-time two-dimensional Doppler flow imaging (2DD: Toshiba SSH 65A) from January to September 1986. Pulsed Doppler, continuous wave Doppler, and M-mode echocardiography were also performed. Patients were examined daily from their admission to 12th day of illness, and after that, more than twice a week until the 28th day of illness. Fourteen of the 17 patients underwent Ga-67 scintigraphy. Cardiac catheterization, including selective coronary arteriography, was performed in 15 patients in the convalescent phase. Mitral regurgitation (MR) was detected in eight of the 17 cases (47%). MR appeared on 2DD 7.5 +/- 1.6th day of illness (mean +/- SD), lasting until 11.9 +/- 5.7th day of illness. MR was transient and mild in degree in all cases, and the regurgitant jet was directed towards the left atrial posterior wall. Neither prolapse nor deformity of the mitral valve was detected. The left ventricular volume indices (determined by the Pombo method) measured by M-mode echocardiography in the acute and convalescent phases were compared. In the group with MR in the acute phase, the end-diastolic volume index was 66.9 +/- 19.9 ml/m2 and the end-systolic volume index was 21.0 +/- 11.7 ml/m2. These were significantly greater than those in the convalescent phase (51.3 +/- 13.1 ml/m2, 14.1 +/- 4.0 ml/m2, respectively). However, no significant differences were observed in the group without MR. Positive uptake of Ga-67 was observed in six patients with MR, but in none of the seven without MR. The incidence of positive uptake was significantly higher in the patients with MR. Cardiac catheterization performed in the convalescent phase revealed that no patient had the findings of MR, other valvular lesions, coronary arterial lesions, or abnormal ventricular performance.
J Cardiol 1987 Sep
PMID:[Mitral regurgitation in the acute phase of Kawasaki disease: scrutiny using real-time two-dimensional Doppler flow imaging]. 345 48

Mitral valve prolapse was echocardiographically examined for 23 female patients with anorexia nervosa. The age was ranged from 13 to 26 and averaged 19.6 years. Their body weights ranged from -25 to -45% of the ideal body weights. Mitral valve prolapse was detected in 19 (83%) cases. The involved valve leaflets were anterior and posterior in 10 and anterior in nine cases, and significant bradycardia was present in the former. Left ventricular end-diastolic dimension was less than the control subjects. The follow-up study in five patients disclosed that each prolapse was unchanged despite of the significant improvement of the disease. The involved mechanism of prolapse in patients with anorexia nervosa was discussed in the light of vagotony based on the pharmacodynamic tests and the results of the previous experimental works of Imataka et al.
J Cardiol Suppl 1987
PMID:[Mitral valve prolapse in patients with anorexia nervosa]. 350 22

Although two-dimensional echocardiography is a standard for diagnosing mitral valve prolapse, the diagnostic criteria are controversial. Regardless of valve ballooning we have used our criteria which are based on the dislocation of the mitral valve coaptation. The purpose of this study was to clarify the relationship between the location and the degree of mitral valve prolapse assessed by two-dimensional echocardiography and those of mitral regurgitation evaluated by color Doppler flow imaging, which enables us detailed analysis of regurgitation. Twenty-three patients with idiopathic mitral valve prolapse diagnosed by our criteria were studied. They were 14 men and nine women, ranging in age from 19 to 72 years (mean 44.7). In any patients, prolapse of either the anterior or posterior leaflet does not satisfy the Gilbert's criteria. Twenty of the 23 patients had mitral regurgitation by color Doppler flow imaging, and the grade was II, III or IV in 16 of these 20 patients. In 19 of 20 patients, the localization of the regurgitant jet flow from the mitral orifice coincided with the two-dimensional echocardiographic site of dislocation of mitral valve coaptation. Therefore, it was concluded that the dislocation of mitral leaflet coaptation detected by two-dimensional echocardiography is an abnormal finding regardless of the protrusion of the valve beyond the mitral ring.
J Cardiol Suppl 1987
PMID:[Relationship of two-dimensional echocardiographic mitral valve prolapse to mitral regurgitation assessed by color Doppler flow imaging]. 350 30

A 40-year-old man was admitted to our hospital in May 1982 for evaluation of a heart murmur. A standard 12-lead electrocardiogram (ECG) showed an abnormal Q wave in lead III. Echocardiography revealed prolapse of the anterior mitral valve leaflet (MVP), but neither dilatation nor wall motion abnormalities of the left ventricle (LV) were observed. Thallium-201 scintigraphy revealed an abnormal thallium uptake at the apex and inferior wall. He had no episode of acute myocardial infarction or myocarditis, but complete right bundle branch block suddenly appeared, and he was hospitalized in October 1984. He had no coronary artery lesions, and only mild mitral regurgitation on left ventriculography. The motion of the interventricular septum and apex was reduced on echocardiography and a persistent perfusion defect was observed at the inferior wall and the interventricular septum on T1-201 scintigraphy. In December 1985, he experienced an Adams-Stokes attack due to complete atrioventricular block. Echocardiographically, the left ventricle became enlarged and the wall motion abnormality and a perfusion defect on T1-201 scintigrams were of relatively severe degree. Thus, left ventricular dilatation and wall motion abnormality may progress in some cases of MVP as it did in this one. We consider this case a very interesting one in speculating on the relationship between MVP and DCM.
J Cardiol 1987 Dec
PMID:[Regression of mitral valve prolapse to a state masquerading as dilated cardiomyopathy: a case report]. 350 16

Pulsed Doppler echocardiography was used to determine prospectively the prevalence of mitral, aortic, tricuspid and pulmonary regurgitation in 80 consecutive patients with mitral valve prolapse and 85 normal subjects with similar age and sex distribution. Mitral valve prolapse was defined by posterior systolic displacement of the mitral valve on M-mode echocardiography of 3 mm or more (40 patients), the presence of one or more mid- or late systolic clicks (61 patients), or both. Mitral regurgitation, detected by pulsed Doppler techniques in 53 patients with prolapse, was holosystolic in 24, early to mid-systolic in 6, late systolic in 15 and both holosystolic and late systolic behind different portions of the valve in 8. Definitive M-mode findings were present in only 27 of the 53 patients, and only 21 had mitral regurgitation audible on physical examination. Tricuspid regurgitation was evident by pulsed Doppler echocardiography in 15 patients (holosystolic in 9, early to mid-systolic in 1, late systolic in 4 and both holosystolic and late systolic in 1); 12 of these 15 patients, including all with an isolated late systolic pattern, had an echocardiographic pattern of tricuspid prolapse, but none had audible tricuspid regurgitation. A Doppler pattern compatible with aortic regurgitation was recorded in seven patients, all without echocardiographic aortic valve prolapse and only two with audible aortic insufficiency. A Doppler shift in the right ventricular outflow tract in diastole, suggestive of pulmonary regurgitation, was recorded in 16 of the 78 patients with an adequate Doppler examination: only 1 of the 16 had audible pulmonary insufficiency. Of the 85 normal subjects without audible regurgitation, pulsed Doppler examination detected mitral regurgitation in 3 subjects (holosystolic in 1 and early to mid-systolic in 2), aortic regurgitation in none, tricuspid regurgitation in 9 (holosystolic alone in 8 and both holosystolic and late systolic in 1) and right ventricular outflow tract turbulence compatible with pulmonary insufficiency in 15. The prevalence of valvular regurgitation, detected by pulsed Doppler echocardiography, is high in patients with mitral valve prolapse. Regurgitation may involve any of the four cardiac valves and is clinically silent in the majority of patients. The prevalence rates of mitral and aortic regurgitation are significantly higher in patients with mitral prolapse than in normal subjects, suggesting that alterations in underlying valve structure in the prolapse syndrome may indeed be responsible for this regurgitation.(ABSTRACT TRUNCATED AT 400 WORDS)
J Am Coll Cardiol 1986 Dec
PMID:Pulsed Doppler echocardiographic evaluation of valvular regurgitation in patients with mitral valve prolapse: comparison with normal subjects. 353 60

In a retrospective ultrasonographic study, 32 cases of acquired disease of the tricuspid valve were detected amongst 7000 consecutive patients. Patients with congenital heart disease (except when the seat of an acquired disease) and with prosthetic heart valves, were excluded. There were twenty-one cases of rheumatic disease, all having additional involvement of the mitral valve. Prolapse (5 patients), bacterial endocarditis (2 patients), rupture of papillary muscle (1 patient), cardiac tumours (2 patients) and carcinoid heart disease (1 patient) were also identified. Acquired disease of the tricuspid valve is infrequently encountered during routine cross-sectional echocardiography but its recognition is clinically important.
Int J Cardiol 1987 Mar
PMID:Acquired abnormalities of the tricuspid valve--an ultrasonographic study. 354 79

Echocardiography has been already applied in previous studies to identify tricuspid valve prolapse. However this anomaly has been found more frequently to be associated with mitral valve prolapse or with other cardiac and lung diseases. Isolated primitive tricuspid prolapse appears in fact a relatively unknown anatomo-clinical entity. In this paper we describe the two-dimensional and Doppler findings of three patients with isolated tricuspid prolapse. Two-dimensional echocardiography is the appropriate technique for its detection and allows the assessment of the echogenic characteristics of the valve texture.
G Ital Cardiol 1987 Mar
PMID:[Isolated tricuspid valve prolapse: identification using 2-dimensional and Doppler echocardiography]. 360 21

Sonocardiography, especially bi-dimensional, currently represents an examination of choice in the detection of valvular prolapses. The authors report one case of a triple aorto-mitral-tricuspid valvular prolapse, diagnosed with the ultrasound technique. In light of this report and the data from the literature, the frequency and the distribution of valvular affections are discussed. The technical difficulties of recording and interpreting sonographic images responsible for false positive or false negative diagnostic errors are also studied.
Ann Cardiol Angeiol (Paris) 1987 May
PMID:[Echocardiographic diagnosis of plurivalvular prolapse. Apropos of a case]. 361 80


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