Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0231807 (exertional dyspnea)
 3,402 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Dynamic mitral regurgitation (MR) is typically associated with either severe systolic left ventricular dysfunction or episodes of acute myocardial ischemia. We report three patients with mild combined mitral stenosis and regurgitation and normal global left ventricular systolic function who presented with severe exertional dyspnea. Upright bicycle exercise echocardiography revealed development of severe dynamic MR in all three cases with Doppler evidence of severe pulmonary hypertension. There was no echocardiographic or electrocardiographic evidence of ischemia. Exercise echocardiography is an established tool for assessing dynamic changes in transvalvar pressure gradients. These results suggest that exercise echocardiography may also be useful for evaluating changes in severity of MR and for the assessment of dynamic changes in pulmonary artery systolic pressures.
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PMID:Exercise echocardiography in combined mild mitral valve stenosis and regurgitation. 1014 21

We report the presence of a post aortic left innominate vein (PALIV) in a patient with a surgically corrected double outlet right ventricle. A 30-year-old male was admitted to our hospital with exertional dyspnea. The patient had undergone right ventricular outflow tract reconstruction and closure of ventricular septal defect at the age of 14. Echocardiography and cardiac catheterization showed severe pulmonary regurgitation and a residual ventricular septal shunt. After resternotomy, right ventricular outflow tract reconstruction and residual shunt closure were performed. During the operation, the left innominate vein was not found in front of the aorta. Postoperative cardiac catheterization and computed tomography showed that the left innominate vein was positioned behind the ascending aorta draining to the superior caval vein.
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PMID:[Post aortic left innominate vein in a patient with a surgically corrected double outlet right ventricle]. 1055 92

Although the results of surgical repair for congenital pulmonary stenosis are generally good, some patients develop progressive symptoms related to pulmonary regurgitation and right ventricular dilation. Pulmonary homograft implantation may have a beneficial effect on these symptoms, due to a reduction in the volume overload of the right ventricle and hemodynamic improvement. We describe our experience of one patient with severe pulmonary regurgitation following pulmonary valvotomy performed with the Brock technique during childhood because of pulmonary valve stenosis. The patient was admitted to our Institution because of dyspnea on exertion (NYHA functional class II-III) and paroxysmal episodes of supraventricular arrhythmias. Echocardiography showed severe pulmonary regurgitation, an important right ventricular dilation associated with severe tricuspid insufficiency and a patent foramen ovale without any significant shunts. Surgical repair was performed through a median sternotomy with cardiopulmonary bypass and moderate hypothermia. The right ventricular infundibulum was opened and a cryopreserved pulmonary homograft was implanted with continuous sutures. De Vega annuloplasty was performed on the tricuspid valve and the patent foramen ovale was closed with a running suture. Postoperative course was uneventful and the patient was discharged on the seventh postoperative day. Three months after surgery the patient is asymptomatic and echocardiographic evaluation shows no evidence of pulmonary or tricuspid regurgitation, a decrease in right ventricular dilation and a significant improvement in biventricular systolic and diastolic function. In conclusion, pulmonary regurgitation after surgical valvotomy can be treated with the implantation of a cryopreserved pulmonary homograft with satisfactory results. It would appear advisable to perform surgical repair of concomitant right heart anomalies, such as secondary tricuspid insufficiency, to obtain both a decrease in right ventricular overload and a regression of its preoperative dilation.
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PMID:[The correction of pulmonary insufficiency with a cryopreserved homograft: an optimal solution to a postoperative problem not rare]. 1083 30

Left ventricular pseudoaneurysm is an uncommon complication of infective endocarditis, usually presenting within several weeks of the infective episode. We describe a 37-year-old man who presented with exertional dyspnea nearly a year after a prolonged hospitalization for lung abscess. Imaging studies showed new aortic valve regurgitation and a giant pseudoaneurysm extending inferoposteriorly from the left ventricle. At thoracotomy, a perforated aortic valve was found, suggesting a healed endocarditis. The patient underwent successful aneurysmectomy and patch closure with aortic valve repair. This case underscores the potential for very late nonvalvular cardiac complications of infective endocarditis and is also distinctive because of the large size of the pseudoaneurysm.
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PMID:A giant left ventricular pseudoaneurysm as a late sequela of aortic valve endocarditis. 1467 2

Abdominal pregnancy is defined as the implantation and development of a fertilized ovum or a embryo in the peritoneal cavity. Although this has been reported in several species, it is considered as a low incidence process. It is classified as a primary abdominal pregnancy, if there is no evidence of uterine rupture, with presumed regurgitation of early embryos from the uterine tube and as a secondary abdominal pregnancy, when there is evidence of uterine rupture. During a necropsy study of 550 adult fertile female New Zealand white rabbits (Oryctolagus cuniculus) from two rabbit farms in Valencia (Spain), the main causes of elimination were studied. Twenty-eight abdominal pregnancies were diagnosed. Seven animals showed no lesions in their reproductive tract. The remaining twenty one animals showed acute or chronic lesions in the reproductive tract. The classification as a primary or secondary condition is discussed. It may be concluded therefore that extrauterine pregnancies would not be such an unusual finding in rabbits, and that this premise should be considered in the diagnostic approach when assessing rabbit doe pathology. New husbandry systems in rabbits such as artificial insemination are factors to be considered.
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PMID:Abdominal pregnancies in farm rabbits. 1522 19

Mitral regurgitation is the second most frequent reason for valve surgery. The most important causes of mitral regurgitation are degenerative valve disease (mitral valve prolapse), left ventricular impairment and dilatation (in coronary artery disease or dilated cardiomyopathy), and infective endocarditis. The regurgitation of blood from the left ventricle into the left atrium leads to dilatation of the left atrium, increase in pulmonary capillary pressure and pulmonary congestion. In chronic severe mitral regurgitation, the left ventricle dilates and becomes impaired over time. Key symptoms are fatigue and dyspnea on exertion. The most prominent physical sign is the characteristic systolic murmur. Echocardiography identifies severity, delineates morphology, and estimates the impact of mitral regurgitation on left ventricular function. Importantly, echocardiography identifies candidates for mitral valve repair. Symptomatic patients and asymptomatic patients with impaired left ventricular function should be operated. If possible, valve repair is preferred over valve replacement to better preserve left ventricular function and to avoid the need for postoperative anticoagulation (except if atrial fibrillation persists).
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PMID:[Mitral regurgitation]. 1628 35

A patient with a history of Hodgkin's lymphoma presented with recurrent left pleural effusions and dyspnea on exertion 27 years after radiation therapy. Further evaluation disclosed suspected radiation-induced constrictive pericarditis, aortic stenosis and regurgitation, and severe coronary artery disease. He underwent successful 3-vessel coronary artery bypass grafting, aortic valve replacement, and pericardiectomy.
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PMID:Three-vessel coronary artery disease, aortic stenosis, and constrictive pericarditis 27 years after chest radiation therapy: a case report. 1684 29

A six-year-old boy presented to the Cardiology clinic with history of mild cyanosis and dyspnea on exertion from age 1. He had a to-and-fro murmur at the middle left sternal border. Chest examination was normal but chest x-ray showed a small left lung. Echocardiography established the diagnosis of tetralogy of Fallot (TOF) and absent pulmonary valve with severe pulmonary regurgitation and moderate stenosis at the pulmonary valve site. There was severe dilatation of the main and right pulmonary arteries. The left pulmonary artery (LPA) could not be seen. Angiography failed to show a LPA. This case of an absent LPA associated with absent pulmonary valve syndrome is discussed and the literature is reviewed.
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PMID:Unilateral absence of a pulmonary artery in absent pulmonary valve syndrome: a case report and review of literature. 1709 83

A 57-year-old woman who complained of exertional dyspnea was diagnosed as having severe aortic valve stenosis and mitral valve regurgitation. The patient underwent double valve replacement with a mechanical prosthesis. Postoperative laboratory data showed unusually high serum lactate dehydrogenase (LDH) levels, even though no perivalvular leakage was detected by echocardiography. Tetany occurred suddenly owing to hypoparathyroidism, which seemed to be a late complication after thyroidectomy. After calcium administration, the symptoms dramatically diminished, as did the serum LDH levels. Hypoparathyroidism should be doubted if serum LDH levels increase higher than the normal range following valve replacement without obvious perivalvular leakage.
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PMID:Unusually high serum levels of lactate dehydrogenase without perivalvular leakage following double valve replacement: predictor of tetany attack after thyroidectomy. 1714

A subset of patients with mitral valve disease has a marked rise in pulmonary vascular resistance (PVR) that is disproportionate to elevations in pulmonary venous pressure. Termed a "hyperactive" pulmonary vasculature, the elevation in PVR falls promptly and dramatically in response to mitral valve replacement. We report a 55-year-old man with progressive, exertional dyspnea of several months' duration who had signs of congestive heart failure (CHF) with moderate mitral valvular regurgitation and aortic stenosis by echocardiographic interrogation. These lesions in combination, together with his CHF and disproportionate elevation in pulmonary artery systolic pressure (90 mm Hg) and PVR (527 dyne x s x cm(-5)), raised the prospect of valvular replacement. There followed a normalization of PVR and marked improvement in his symptoms and signs of CHF in response to pharmacologic management with an ACE inhibitor, loop diuretic, and aldosterone receptor antagonist to negate any further consideration of surgery.
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PMID:A hyperactive pulmonary vasculature in response to chronic mitral regurgitation. 1757 Sep 95


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