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At least 307 records · Page 17Linked to original sources
PubMed1987

[Mitral regurgitation in mitral valve prolapse: its mechanisms and time course].

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.

Adult↗
PubMed1986

The pathogenesis and pathophysiology of rectal prolapse and solitary rectal ulcer syndrome.

Rectal prolapse and solitary rectal ulcer syndrome are both benign conditions affecting the rectum, mainly in women; prolapse tends to occur late in life, while solitary rectal ulcer syndrome has a predilection for the younger adult. Complete rectal prolapse probably starts as a mid-rectal intussusception, although a combination of this theory and the 'sliding hernia' theory has been proposed by Altemeier et al (1971). The pelvic floor weakness associated with prolapse, which gives rise to incontinence, is most likely due to a traction injury to the pudendal nerve. Anorectal manometry will indicate those incontinent patients likely to benefit from rectopexy. Abnormal descent of the perineum may be found in rectal prolapse and solitary rectal ulcer syndrome as well as descending perineum syndrome per se. The clinical features of these three conditions can overlap. Solitary rectal ulcer syndrome is essentially due to prolapse and traumatization of the rectal mucosa. Inappropriate puborectalis contraction, abnormal perineal descent, and overt rectal prolapse have all been cited as possible mechanisms of development of the condition. Defecography is the radiologic investigation of choice. Electromyography, as in rectal prolapse, may show evidence of pudendal nerve damage although incontinence is rare.

Adult↗
PubMed1986

[Two-dimensional echocardiographic diagnosis of mitral valve prolapse].

In recent years, echocardiography has become the standard method of diagnosing mitral valve prolapse. There is a few criteria of diagnosing mitral valve prolapse with two-dimensional echocardiography. In general, the definition of mitral valve prolapse with two-dimensional echocardiography is the motion of a bodily part of the anterior or posterior mitral leaflet superior to the annulus during systole. However, the patients with characteristic phonocardiographic findings of mitral valve prolapse were overlooked by the currently used criteria. I proposed, therefore, an essentially different two-dimensional echocardiographic criterion of diagnosing mitral valve prolapse. The criterion included the systolic dislocation of the anterior and posterior mitral leaflets at the coaptation zone in the parasternal long-axis view. This diagnostic criterion enabled us to obtain a systematic view of the mitral valve abnormality. Quantitation of mitral valve prolapse is necessary to evaluate the severity of the mitral regurgitation and the degree of mitral valve lesion. The grade of severity of mitral valve prolapse was assessed by measuring the distance of dislocation between the anterior and posterior leaflets at the area of coaptation. Analyzed data using this method showed that the degree and extent of mitral valve prolapse increased with age.

Echocardiography↗
PubMed1997

[Ventricular arrhythmias in patients with mitral valve prolapse and spurious cords in heart ventricles].

The aim of the work to assess the frequency of ventricular arrhythmias in patients with isolated mitral valve prolapse isolated spurious cords in heart ventricles as well as in those patients who had both, mitral valve prolapse and spurious cord in heart ventricle. Out of 4156 successive electrocardiographic investigations carried out at the Department and Clinic of Cardiology, Medical Academy in Wroclaw, coexistence of spurious cords in heart ventricle and mitral valve prolapse was diagnosed in 32 patients (0.8% of all subjects), isolated mitral valve prolapse--in 184 patients (4.4%) and presence of isolated spurious cords not accompanied by mitral valve prolapse--in 91 patients (2.2%). In 20 patients with coexistence of spurious cords in heart ventricles and mitral valve prolapse, ventricular arrhythmias occurred in 12 subjects (60.0%) and in 5 of them they were significant. In the group of 29 patients with isolated spurious cords, disturbances of the ventricular rhythm occurred in 13 subjects (44.8%), while significant ventricular arrhythmias were found in 6 patients (20.7%). Out of 60 subjects with isolated mitral valve prolapse disturbances of the ventricular rhythm were found in 20 patients (33.3%) and significant arrhythmias--in 12 subjects (20.0%). The observations did not reveal increased prevalence of significant ventricular disturbances of the heart rhythm in patients with coexisting mitral valve prolapse and spurious cords in the heart ventricles.

Adult↗
PubMed1998

[Pitfalls in echocardiographic diagnosis of mitral bileaflet prolapse].

Preoperative echocardiography provides good planning information for successful repair of mitral valve regurgitation, but identifying the prolapse of both the anterior and posterior leaflets is sometimes difficult. To clarify the cause of this problem, preoperative echocardiographic findings and intraoperative observations of the prolapse were analyzed in 124 patients with non-rheumatic pure mitral regurgitation. In 48 patients with final diagnoses of bileaflet prolapse, 16 (33%) were considered to have only single leaflet prolapse before the operation. Anterior leaflet prolapse was overlooked in 14, and prolapse of either of its commissural segments was the least detectable by echocardiography. Chordal rupture was seen more in the posterior leaflet than in the anterior leaflet. Movement of the anterior leaflet may be influenced by a prolapsed and hypermobile posterior leaflet and/or regurgitant jet flow caused by the posterior leaflet prolapse.

Chordae Tendineae↗
PubMed2004

Mechanical devices for pelvic organ prolapse in women.

BACKGROUND: Pelvic organ prolapse is common, with some degree of prolapse seen in up to 50% of parous women in a clinic setting although many are asymptomatic. A number of symptoms may be associated with prolapse and treatments include surgery, mechanical devices and conservative therapies. A variety of mechanical devices or pessaries are described which aim to alleviate the symptoms of prolapse and avert or delay the need for surgery. OBJECTIVES: To determine the effects of mechanical devices for pelvic organ prolapse. SEARCH STRATEGY: We searched the Cochrane Incontinence Group trials register (24 February 2004), MEDLINE (January 1966 to January 2003), PREMEDLINE (15 January 2003), EMBASE (January 1996 to January 2003), CINAHL (January 1982 to February 2003), PEDro (October 2003), the UK National Research Register (Issue 3, 2003), Controlled Clinical Trials (April 2003) and ZETOC (April 2003). We searched the reference lists of relevant articles. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials which included a mechanical device for pelvic organ prolapse in one arm of the study. DATA COLLECTION AND ANALYSIS: No eligible, completed, published or unpublished randomised controlled studies were found, therefore no data collection or analysis was possible. MAIN RESULTS: There was a dearth of studies on the use of mechanical devices and no published reports of randomised trials were identified. One study on pessary usage was excluded as it was not a randomised trial. REVIEWERS' CONCLUSIONS: Currently there is no evidence from randomised controlled trials upon which to base treatment of women with pelvic organ prolapse through the use of mechanical devices/pessaries. There is no consensus on the use of different types of device, the indications, nor the pattern of replacement and follow-up care. There is an urgent need for randomised studies to address the use of mechanical devices in comparison with no treatment, surgery and conservative measures.

Female↗
PubMed1977

Echocardiographic spectrum of mitral valve motion in children with and without mitral valve prolapse: the nature of false positive diagnosis.

To examine problems in echocardiographic diagnosis of mitral valve prolapse, multiple crystal cross-sectional echocardiography and single crystal recordings derived from the multiple crystal array were used to study 45 clinically normal children aged 3 to 15 years (Group A), 26 children aged 2 to 10 years with known mitral valve prolapse (Group B), 12 children with a catheterization-proved large left to right shunt at the ventricular level (Group C) and 8 children with catheterization-proved left ventricular outflow tract obstruction (Group D). Children in Groups A and B were not studied hemodynamically. Children in Groups C and D had no evidence of mitral valve prolapse on angiography and were studied echocardiographically to determine the effect of changes in ventricular shape on the patterns of mitral valve motion. In the real time cross-sectional studies, normal patients demonstrated a spectrum of mitral valve motion in which the bodies of the anterior and posterior leaflets became slightly horizontal with systolic ejection. The mitral apparatus assumed a curvilinear funnel shape. Arching of the leaflets into a horizontal configuration was more striking in the presence of either left ventricular dilatation in left to right shunt or involvement of the anterior mitral anulus in subaortic stenosis (two patients) and was associated with false positive M mode tracings suggesting mitral valve prolapse. This latter configuration was easily differentiated from the superior motion of the body of the leaflets in true prolapse. Studies of single crystal M mode recordings derived form the cross-sectional array in known locations from six normal patients revealed M mode patterns of pseudoprolapse in tracings derived from the leaflet body and patterns of normal motion at the free edge. In contrast, superior-posterior prolapse visualized in cross-sectional studies in patients with the click-murmur syndrome was associated with abnormal M mode recordings from all parts of the leaflet, including the free edge, although the abnormalities were most striking in tracings derived from the leaflet body. The M mode echocardiographic findings of mitral valve prolapse in both normal patients and patients with the click-murmur syndrome were dependent upon transducer angulation and the portion of the valve examined. The critical differentiation of the spectrum of normal valve motion from prolapse requires careful evaluation of echoes from the free edge of the leaflet where the posterior and anterior leaflet echoes coapt in early systole.

Adolescent↗
PubMedDate not supplied

Radiofrequency coagulation with Thiersch's operation--a better palliative treatment in prolapse rectum.

PURPOSE: Thiersch operation is an age-old popular option for treatment of complete rectal prolapse (proctodentia) in elderly patients. This procedure is simple, easy to perform, and with very rare postoperative complications of any severe nature. This is especially suitable for those patients who are unfit for extensive abdominal surgical procedures in practice today. This procedure does help in mechanically supporting and containing the prolapse. Although the procedure is not curative, the confining of the prolapse in the anal canal does ensure a relief from symptoms generated by the prolapse. Nevertheless, withdrawal of the occlusive material used is inevitably followed by recurrence of the prolapse, making the procedure a failure in achieving a prolonged relief. METHODS: Looking at this drawback, we have made an addition to this conventional procedure by introducing circumferential coagulation of the subanodermal region through a radio frequency device. This results in inducing fibrosis and forming a zone of band. The added maneuver constricts the anal opening permanently and thus aids in reinforcement of the atonic sphincter. The study was carried out in 8 patients. Their average age was 57 years. All of them had complete prolapse of the rectum with associated features. Two of them were in early fifties, but they refused to undergo extensive procedures and opted for this method considered cheaper and quicker. RESULTS: A follow-up for a period ranging from 15 to 18 months was found satisfactory. None of the patients had any prolapse or its sequel. Not a single case was reported for any sinus or discharge from the site of incision. The incision site was well consolidated, and the knot or the thread could not be felt when seen after 12 months. CONCLUSIONS: The study shows that radio frequency coagulation followed by Theirsch operation for complete rectal prolapse in the elderly has been found to be relatively easy to perform. Except for the radio surgical unit, no special instrumentation is needed. The results of this procedure have been found to be gratifying in all the patients. It is felt that on appropriate selection of the patients and employing this new technique of operation would prove a boon in treatment of this problem. A further work in this direction and longer follow-up of the treated patients are bound to bring about exciting new dimensions in the field.

Journal Article↗
PubMedDate not supplied

Effectiveness of a prolapsed bird's nest filter.

PURPOSE: The authors evaluated the variable deployment of the Bird's Nest filter, including frequency and extent of prolapse in clinical use, and analyzed the effects of this variability on clot-trapping efficiency with an in vitro model. MATERIALS AND METHODS: In the clinical placement of 20 filters, the average length of cephalic filter wires from the center of the filter was measured from radiographs obtained immediately after placement. To analyze the effects of prolapse, a variable-rate pump was used to mimic the effects of respiration on IVC flow. Four clot sizes (5 x 20, 5 x 40, 10 x 20, and 10 x 40 mm) were evaluated with four filter configurations with wires stretched to different lengths in a cephalic direction from the center of the filter: 2 cm (normal-tight), 5 cm (normal-loose), 8 cm (moderate prolapse), and to a maximum of 12 cm (maximum prolapse). Ten passes for each clot size were performed with each filter configuration in both the horizontal and vertical positions. The smallest clots were also tested with a slower constant-rate pump. RESULTS: In clinical use, the average length of the filter wire was 5.4 cm (range, 1.2-9.0 cm). With the variable flow pump, the in vitro degree of prolapse did not significantly decrease the trapping efficiency for any but the smallest (5 x 20-mm) clots, for the maximum prolapse configuration in the horizontal position (P = .01). In addition, for these clot sizes, the filter was more efficient with the slower constant rate compared with the faster variable rate; this difference was only statistically significant in the horizontal position for the maximum prolapse configuration (P = .007). CONCLUSION: The results suggest that in clinical practice, a prolapsed Bird's Nest Filter remains effective for all but small clots.

Blood Flow Velocity↗
PubMed2006

Dynamic pelvic three-dimensional computed tomography for investigation of pelvic abnormalities in patients with rectocele and rectal prolapse.

BACKGROUND: Dynamic three-dimensional computed tomography (D-3DCT: high-speed helical scanning during defecation) was used for morphological evaluation of intrapelvic structures in patients with rectal prolapse and rectocele. METHODS: Twenty-five patients with rectal prolapse or rectocele diagnosed by conventional defecography (CD) or clinical findings were additionally investigated with D-3DCT. D-3DCT images were acquired using a multislice CT system with a 16-row detector during simulated defecation. Helical scanning was performed with a slice thickness of 1 mm, a helical pitch of 15 s/rotation, and a table movement speed of 35 mm/s. The contrast medium, 100 ml of iopamidol (370 mg/ml), was injected at a rate of 2.5 ml/s to enhance contrast with other structures, and scan start was triggered by using a function for automatically determining the optimal scan timing. RESULTS: Among the eight patients with rectocele, additional intrapelvic disorders were diagnosed in five (enterocele, 4; cystocele, 1; and uterine prolapse, 1) with D-3DCT. In the 17 patients with rectal prolapse, concomitant intrapelvic disorders were found in six (intussusception, 3; cystocele, 2; uterine prolapse, 2; rectocele, 1; and vaginal prolapse, 1). CONCLUSIONS: D-3DCT can be a useful diagnostic tool for investigation of pelvic pathology in patients with rectocele and rectal prolapse.

Adult↗
PubMed2005

The role of the MR-fluoroscopy in the diagnosis and staging of the pelvic organ prolapse.

INTRODUCTION: The aim of the study is to investigate the efficacy of the magnetic resonance fluoroscopy in the diagnosis and staging of the pelvic prolapse. MATERIALS AND METHODS: The study consisted of 46 patients who were known to have pelvic prolapses from their vaginal examination. Thirty women who underwent vaginal exam and shown not have pelvic prolapse were selected as a control group. Firstly, pelvic sagittal FSE T2 weighted images of all the women were acquired in 0.3 T open MR equipment than sagittal MR-fluoroscopic images using spoiled gradient echo sequences were obtained during pelvic strain. Physical examination and MR-fluoroscopic findings were compared. The relationship between the stages of prolapse established by both of the methods was evaluated statistically with Pearson's correlation analysis. RESULTS: Physical examination and MR findings were very concordant in the diagnosis of pelvic prolapse and statistical correlations in the stages of prolapse were established between both of the methods (P<0.01 for anterior and middle comportment, P<0.05 for posterior comportment). CONCLUSION: We conclude that MR-fluoroscopy is a non-invasive, easily applied, dynamic useful method without contrast agent in the diagnosis and staging of pelvic organ prolapse.

Adult↗
PubMed1999

Prevalence of hydronephrosis in patients with genital prolapse.

OBJECTIVE: To determine the prevalence of hydronephrosis in patients with genital prolapse and evaluate contributing factors. METHODS: Retrospective study of the records of 189 patients with pelvic organ prolapse who underwent preoperative renal imaging studies. RESULTS: Of the 189 patients 31 (17.4%) had hydronephrosis; in 20 (10.6%) patients the hydronephrosis was mild, in 7 (3.7%) it was moderate and in 4 (2.7%) it was severe. The patients with hydronephrosis were older (mean age 68+/-9.5 SD vs. 60.5+/-10.8 SD, P<0.001) had a higher creatinine levels (0.84+/-0.4 SD vs. 0.78+/-0.3 SD P<0.005) and had a higher degree of uterine prolapse (mean 2.6+/-0.9 SD vs. 1.1+/-1.2 SD, P<0.005). After adjusting for age and type of prolapse, only patients with uterine prolapse remained significantly more likely to suffer from hydronephrosis (adjusted odds ratio 1.9, 95% CI 1.1, 3.2). CONCLUSION: The prevalence of hydronephrosis in patients with genital prolapse is appreciable and is related primarily to degree of uterine prolapse.

Aged↗
PubMed1999

[Importance of defecography in the evaluation of genital prolapses].

OBJECTIVE: To determine the interest of defecography for the initial evaluation of genital prolapses. PATIENTS AND METHODS: A retrospective study of 125 patients who had undergone systematically a defecography for the initial evaluation of a genital prolapse. RESULTS: 10% of defecogaphies were normal. On clinical examination a rectocele was found in 94% of patients and an enterocele in 33%. At defecography, these abnormalities were seen only in 39% and 15% respectively. 39% of patients with radiological rectocele had an intussusception at defecography. CONCLUSION: Defecography is appropriate to diagnose and to assess constitutional abnormalities associated with genital prolapse (rectocele, enterocele) and other anomalies which interact with it (intussusception, sphincter and pubo-rectal dyskinesia). Most of women with genital prolapse showed abnormal defecograms. We observed a marked discordance between clinical and radiological evaluation, specially for rectocele. Defecography is of great interest in the evaluation of posterior genital prolapses, specially in women complaining of dyschesia. Defecography may be proposed in case of: posterior vaginal wall prolapse (rectocele, enterocele), dyschesia, post-operative prolapse and before a cervicopexy.

Defecography↗
PubMed1995

Anterior vaginal suspension for vaginal vault prolapse.

Vaginal prolapse may occur following hysterectomy or may evolve with the uterus in place. Current treatment options for vaginal prolapse have a limited success rate or are associated with significant morbidity. In this retrospective review, we present our experience with a new procedure for repair of vaginal prolapse. This technique relies on anterior suspension of the vaginal vault to the anterior rectus sheath in a fashion similar to bladder neck suspension. Forty patients have undergone this procedure. All patients had vaginal prolapse, cystocele, and urinary incontinence. In addition, 34 patients had enterocele, six had uterine prolapse, 33 had rectocele, and two had urethral diverticula. All patients had anterior vaginal suspension (AVS), with cystocele repair and bladder neck suspension. Six patients had vaginal hysterectomy, 34 had enterocele repair, 33 had rectocele repair, and two had urethral diverticulectomy. The mean hospital stay was 2.5 days (range, 1-7 days), and their mean follow-up was 30 months (range, 12-54 months). Thirty-six (90%) patients have excellent support of the vagina with no evidence of recurrent cystocele, enterocele, or rectocele. Four (10%) patients have recurrent enterocele. Thirty-three (82.5%) patients are dry or have rare episodes of urinary incontinence (less than one episode/month), whereas four (10%) patients have recurrent stress incontinence and three (7.5%) have urge incontinence. Constipation and fecal incontinence were resolved in all patients. All patients who were sexually active preoperatively remained so postoperatively, and none reported dyspareunea. Vaginogram in 10 patients demonstrated that posterior angulation of the vaginal axis was retained in all patients. AVS is associated with an excellent success rate in terms of resolution of symptoms and correction of prolapse. Morbidity is minimal, and hospital stay is short. The technique is simple and relies on anatomy that is familiar to all urologists. In addition, the vaginal approach allows for simultaneous correction of all components of vaginal prolapse and any associated vaginal pathology.

Adult↗
PubMed2003

Long-term follow-up of the modified Delorme procedure for rectal prolapse.

HYPOTHESIS: The modified Delorme operation is a safe, effective, and durable treatment for complete rectal prolapse. DESIGN: Retrospective analysis of outcomes in adult patients undergoing the modified Delorme operation. SETTING: Community-based tertiary referral center with a 5-year general surgery residency program. PATIENTS: A total of 52 consecutive patients undergoing surgery for the treatment of complete rectal prolapse during the 26-year period ending December 2001. INTERVENTIONS: Modified Delorme operation. Main Outcomes Measured Method of anesthesia, morbidity, mortality, recurrence rates, length of follow-up, and incontinence. RESULTS: In the 52 patients, the mean length of prolapse was 8.2 cm. The mean operating time was 75 minutes. Forty-five patients were administered general anesthesia, 4 were administered spinal anesthesia, and 3 were administered local anesthesia. The mean postoperative stay was 4.9 days for 1975 through 2001 and 2.8 days for 1990 through 2001. No patients died as a result of the procedure. Patients were followed up for 61.4 months. Major medical comorbidities occurred in 40 patients. Preoperative incontinence was present in 12 patients, 10 of whom improved after the procedure, and postoperative incontinence in 8. The recurrent postoperative prolapse rate at 5 years was 6% (3/52) and the recurrent postoperative prolapse rate to the end of the study was 10% (5/52). Two patients (4%) had complications that required operative intervention in the postoperative period. CONCLUSIONS: The modified Delorme operation is a safe and effective surgical treatment for complete rectal prolapse. The risk of recurrent prolapse is low, and the procedure may be safely performed in patients with significant medical comorbidities.

Adult↗
PubMed1985

Mitral valve prolapse in sickle cell disease: manifestation of a generalized connective tissue disorder.

Previous studies have shown an association of sickle cell disease with generalized connective tissue disorders such as pseudoxanthoma elasticum. We recently documented an unexpectedly high prevalence of mitral valve prolapse, a connective tissue disorder, in sickle cell disease. To investigate this association, skin biopsies were analyzed from 32 sickle cell disease patients, 11 of whom had mitral prolapse. Total and type III collagen, collagen solubility, and uronic acid were not different between the patients with or without mitral prolapse (p greater than 0.05). Computerized morphometric quantitation of the volume fraction of elastic fibers was greater in sickle cell disease patients than in 10 normals (3.1 +/- 0.1 mean +/- SEM vs 2.0 +/- 0.3%; p less than 0.01) but less than in three patients with pseudoxanthoma elasticum (9.7 +/- 0.6%; p less than 0.001). Desmosine radioimmunoassay (an index of elastic fibers) was greater in sickle cell disease patients with mitral prolapse than those without (239.3 +/- 9.3 vs 171.7 +/- 25.4 ng/mg wet weight; p less than 0.02). Histopathologic grading showed a similar trend (p = 0.07). The combined probabilities of these three independent tests of elastic fiber quantity showed an increased elastic fiber concentration in mitral prolapse patients compared to those without mitral prolapse (p less than 0.02). Thus, there is no evidence for a specific collagen defect; rather, sickle cell disease appears to be associated with a spectrum of elastic tissue disorders, a feature that could predispose to mitral valve prolapse.

Adolescent↗
PubMed1986

Prevalence of mitral-valve prolapse in the Stickler syndrome.

An increased prevalence of mitral-valve prolapse occurs in several connective tissue dysplasias, including Marfan syndrome, Ehlers-Danlos syndrome, and pseudoxanthoma elasticum. We evaluated 57 patients diagnosed as having the Stickler syndrome for mitral-valve prolapse by auscultation and two-dimensional echocardiography. The diagnosis was made on the basis of craniofacial and musculoskeletal abnormalities, sensorineural hearing loss, eye defects, and a family history of Stickler syndrome. Twenty-six patients (45.6%) had mitral-valve prolapse, including 11 of 22 females (50.0%) and 15 of 35 males (42.9%). The age range of our study population was 4 to 60 years. Prevalence of mitral-valve prolapse did not increase with age. Nine patients (34.6% of those with mitral-valve prolapse) had the click-murmur syndrome; only one of them was symptomatic. Because of the growing list of complications associated with mitral-valve prolapse, all patients with Stickler syndrome should be evaluated by auscultation, electrocardiogram, and echocardiography. Those with mitral-valve prolapse should be advised to have periodic follow-up and to instruct physicians caring for them of their need for antibiotic prophylaxis with certain surgical procedures.

Adolescent↗
PubMed1986

Vertical left ventricular angulation assessed by thallium 201 myocardial perfusion imaging in patients with mitral valve prolapse.

Mitral valve prolapse has been associated with septal to aortic root angle abnormalities determined by echocardiography. Thallium 201 imaging in the anterior view permits visualization of the left ventricular long axis. In the present study, the vertical angle was defined as the angle formed by the long axis of the left ventricle and a horizontal line. The vertical angle was determined in 25 patients who had 201 TL stress testing and M-mode echocardiography. Group I (11 patients) had mitral valve prolapse and group II (14 patients) did not have mitral valve prolapse. The vertical angle and ultrasound were read blinded to each other. Height, weight, and body surface area were compared for the two groups, and receiver operator curve analysis performed. Vertical angle measured by TL 201 was significantly more vertical in patients with mitral valve prolapse. Receiver operator curve analysis showed that an angle of greater than 30 degrees successfully identified 9/11 patients with mitral valve prolapse, with a sensitivity of 82% and a specificity of 79%. There were no significant differences in height, weight, or body surface area between the two groups. Thus, patients with mitral valve prolapse have more vertically positioned hearts than patients without mitral valve prolapse, independent of body habitus. The different appearance of a vertically oriented heart may contribute to false-positive readings of TL 201 images.

Adult↗