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PubMed1979

Platelet survival time and thromboembolism in patients with mitral valve prolapse.

Thromboembolism (TE) occurs in about 20% of patients with rheumatic mitral valve disease, and platelet survival time in these patients has correlated with TE. In patients with mitral valve prolapse, TE appears to occur very infrequently. Platelet survival (autologous labeling with chromium-51) was performed in 26 patients with mitral prolapse. Five patients had a history of stroke, as well as normal cerebrovascular arteriography and shortened platelet survival (average half-time +/- SEM 2.3 +/- 0.18 days; normal half-time 3.7 +/- 0.03 days; n = 26; p less than 0.01). Platelet survival was shortened in seven of 21 patients without TE (33%) (3.3 +/- 0.06 days; p less than 0.01 vs patients with TE). In 138 patients with rheumatic heart disease, platelet survival was shortened in 40 of 41 (98%) with a history of TE (2.3 +/- 0.08 days) and in 76 of 97 (78%) without TE (2.9 +/- 0.07 days; p less than 0.001 vs patients with TE). In patients with mitral prolapse, sulfinpyrazone increased platelet survival (2.4 +/- 0.16 to 2.7 +/- 0.19 days; n = 7; p less than 0.05). Our results suggest that platelet survival time is shortened in patients with mitral prolapse and rheumatic heart disease who have had TE. Of those without TE there is an increased frequency of shortened platelet survival in patients with rheumatic heart disease (78%) compared with those with mitral prolapse (33%), consistent with the infrequency of TE in mitral prolapse.

Adult↗
PubMed1981

Mitral valve prolapse: a consistent manifestation of type IV Ehlers-Danlos syndrome. The pathogenetic role of the abnormal production of type III collagen.

To evaluate whether abnormal production of type III collagen, the characteristic biochemical feature of patients with the type IV Ehlers-Danlos syndrome, consistently predisposes to mitral valve prolapse, we evaluated the family of a proband with classic type IV Ehlers-Danlos syndrome. Production of type III collagen was assessed with the use of cultured skin fibroblasts. Mitral valve prolapse was detected by M-mode and two-dimensional echocardiography. Biochemical abnormalities in the production of type III collagen and echocardiographic findings of mitral valve prolapse were completely concordant. All patients with abnormal production of type III collagen had mitral valve prolapse and all subjects with normal production of type III collagen had entirely normal echocardiograms. Six of the eight patients with abnormal production of type III collagen had subtle cutaneous abnormalities. The consistent association of abnormal production of type III collagen and mitral valve prolapse in this family suggests that this abnormality of collagen may give rise to mitral valve prolapse.

Adolescent↗
PubMed1988

Mitral valve prolapse in patients with prior rheumatic fever.

It is known that rheumatic heart disease frequently results in isolated mitral regurgitation without concomitant mitral stenosis, especially in countries with a high prevalence of rheumatic fever. However, more recent surgical pathologic data also have demonstrated a high incidence of mitral valve prolapse in cases of rheumatic heart disease, which suggests that rheumatic fever may be a cause of mitral valve prolapse. To determine whether this association of mitral valve prolapse and rheumatic heart disease is present in a stable clinic population, we studied 30 patients who had an apical systolic murmur and a well-documented history of rheumatic fever with dynamic auscultation, two-dimensional echocardiography, and pulsed Doppler examinations. Twenty of the 30 patients (67%) had findings on physical examination consistent with isolated mitral regurgitation and 25 patients (84%) had mitral regurgitation by Doppler examination. Echocardiography demonstrated mitral valve prolapse in 24 patients (80%), whereas only one of the total study group had echocardiographic findings consistent with mitral stenosis. We conclude that (1) the presence of an isolated systolic murmur in patients with a history of rheumatic fever frequently represents pure mitral regurgitation secondary to mitral valve prolapse and (2) postinflammatory changes in valvular tissue resulting from rheumatic fever may be the etiology of mitral valve prolapse in these patients.

Adult↗
PubMedDate not supplied

Cerebral ischemic attacks as a complication of aortic and mitral valve prolapse.

The high incidence of mitral valve prolapse (MVP) in patients with ischemic attacks is puzzling when compared with the very low incidence of cerebrovascular attacks observed in individuals known to have MVP. Our aim was to determine if it is possible to identify a patient subset with MVP at the highest risk of embolization on the basis of 2D-echocardiographic findings. We compared the echocardiographic picture of a group of 39 patients with MVP and cerebral ischemic attacks (29 TIAs, 10 strokes) in the carotid territory, without any pathological lesions at angiography, with that of a control group of 111 patients with MVP without neurological complications. The two groups were not different for age or sex. Patients with MVP and neurological complications showed a higher prevalence of aortic valve prolapse (62% vs 34%, p less than 0.01), of an association between valvular diffuse thickening and aortic valve prolapse (54% vs 23%, p = 0.001), and of multiple valve prolapse with valvular diffuse thickening (26% vs 7%, p less than 0.01) than those of the control group. This study suggests that in young people cerebral ischemic events could be related to the presence of a combined valve prolapse and to an echocardiographic picture of valve diffuse thickening. These data suggest that in this selected group with multiple valve prolapse and valvar diffuse thickening prophylaxis against embolic events by pharmacological preventive measures should be considered.

Adolescent↗
PubMed2003

Management of rectal prolapse: the role of laparoscopic approaches.

Rectal prolapse is a lifestyle-altering disability which has been treated with over 100 surgical options. The specific goals of surgical management of full thickness rectal prolapse are to minimize the operative risk in this typically elderly population, eradicate the external prolapse of the rectum, improve continence, improve bowel function, and reduce the risk of recurrence. The theoretical advantages of a laparoscopic approach are to couple reductions in surgical morbidity and good post-operative outcome. Studies which compare the same laparoscopic and open surgical approach for rectal prolapse have demonstrated that laparoscopy confers benefits related to postoperative pain, length of hospital stay, and return of bowel function. Virtually every type of open transabdominal surgical approach to rectal prolapse has been laparoscopically accomplished. Current laparoscopic surgical techniques include suture rectopexy, stapled rectopexy, posterior mesh rectopexy with artificial material, and resection of the sigmoid colon with colorectal anastomosis, with or without rectopexy. The growing body of literature supports the concept that laparoscopic surgical techniques can safely provide the benefits of low recurrence rates and improved functional outcome for patients with full thickness rectal prolapse.

Humans↗
PubMed1983

Echocardiographic evaluation of aortic cusp prolapse in children with ventricular septal defect.

Echocardiograms were obtained from 48 Japanese children with ventricular septal defect (16 having aortic cusp prolapse, Group I, and 32 without it, Group II). In the case of right coronary cusp prolapse, the right coronary sinus protrudes anteriorly into the right ventricular outflow tract, and thus, the anteroposterior diameter of the aortic root increases. In the case of non-coronary cusp prolapse, the non-coronary sinus bulges posteriorly into the right ventricle, and thus, the aortic root increases in size. For evaluating the degree of these prolapses quantitatively, we measured the aortic root diameter echocardiographically and expressed them as a percent of a normal one. In Group I the aortic root diameter was 131 +/- 9% (mean +/- SD) and in Group II it was 105 +/- 7%, and the difference between the 2 groups was statistically significant (p less than 0.001). In Group I 14 of the 16 patients had a value greater than 120%, while all 32 patients of Group II had a value smaller than 120%. Thus, in children with ventricular septal defect, an aortic root diameter greater than 120% of normal suggests the presence of aortic cusp prolapse. Systolic semiclosure of the aortic valve was found in 8 patients of Group I (50.0%) and in 2 of Group II (8.7%). Coarse systolic fluttering of the pulmonary valve with an amplitude of greater than 3 mm was detected in 6 of Group I (40.0%) and in 3 of Group II (10.0%). Therefore, semiclosure of the aortic valve and fluttering of the pulmonary valve are considered to be also useful for evaluating aortic cusp prolapse qualitatively.

Adolescent↗
PubMed1990

Clinical and exercise echocardiographic findings in patients with mitral valve prolapse.

To assess the relationship between left ventricular functional reserve and prognosis in patients with idiopathic mitral valve prolapse, ergometer exercise echocardiography was performed in 10 normal subjects and 30 patients with mitral valve prolapse having either mild, or no mitral regurgitation. These 30 patients with mitral prolapse were followed for 2 to 8 (mean 4.5) years. Increment of % fractional shortening during maximum exercise at the initial study in patients with mitral valve prolapse and normal subjects were 7 +/- 7 and 11 +/- 3%, respectively. Based on increment of % fractional shortening, patients with mitral valve prolapse were divided into 2 groups; Group I: 13 cases with delta% fractional shortening less than 5%, Group II: 17 cases with delta% fractional shortening greater than or equal to 5%. The incidence of cardiac symptoms was higher in Group I than in Group II (85 vs 41%, p less than 0.05). ST-T changes and life-threatening arrhythmias were more frequently observed in Group I. During the follow-up period, M-mode echocardiographic measurements did not vary in Group II, but left ventricular and left atrial dimensions increased significantly (p less than 0.05, p less than 0.01, respectively) and % fractional shortening decreased significantly (p less than 0.01) in Group I without any change in mitral regurgitation severity. Thus, some patients with mitral valve prolapse not having significant mitral regurgitation may develop progressive deterioration of the cardiac function, which may be predicted by exercise echocardiography.

Adult↗
PubMed1981

Apical cross-sectional echocardiography. Standard for the diagnosis of idiopathic mitral valve prolapse syndrome.

In light of the nonspecificity of left ventricular angiography and physical examination, and the limitations of M-mode echocardiography to define the presence of mitral valve prolapse syndrome, we evaluated left ventricular longitudinal and apical four-chamber tomographic views of cross sectional echocardiography in 19 subjects with normal left ventricular cineangiography and in 5 patients with congestive cardiomyopathy. None had auscultatory findings suggestive of mitral valve prolapse syndrome. In all 24 control subjects, the apical view demonstrated the coaptation point and the leaflets of the mitral valve to lie inside the left ventricular cavity. A retrospective analysis of 900 consecutive cross sectional echocardiographic studies revealed 105 subjects with no evidence of structural heart disease other than the presence of the mitral valve leaflets in the left atrium in systole defining the existence of idiopathic mitral valve prolapse syndrome. Both mitral leaflets were prolapsed in 90 percent of the involved populations, and the apical tomographic cross sectional echocardiographic view was superior to the left ventricular longitudinal view for the detection of anterior leaflet prolapse. These data suggest that the apical cross sectional view may be the single best technique to define the presence of idiopathic mitral valve prolapse syndrome.

Adolescent↗
PubMed1992

Submucosal uterine leiomyomas: diagnosis of prolapse into the cervix and vagina based on MR imaging.

OBJECTIVE: We describe the MR appearance, signs and symptoms, and pathologic findings in five patients with submucosal leiomyomas that prolapsed into the cervical or vaginal canal. SUBJECTS AND METHODS: During the past 3 years, five women aged 33-53 years (mean, 43 years) were identified prospectively at MR imaging as having prolapsing uterine leiomyomas. The diagnosis was confirmed by surgical pathology. MR imaging was performed on a 1.5-T unit, using both T1- and T2-weighted spin-echo or fast spin-echo sequences. The images were analyzed for signal intensity, presence of a stalk, and caudal extent of the prolapsed leiomyoma. RESULTS: These leiomyomas, the presence of prolapse, and the caudal extent of prolapse were detected prospectively on MR images in all five cases. Prospective localization of the stalk in two cases aided subsequent hysteroscopic resection. MR imaging correctly indicated the presence of hemorrhage in one, degeneration in a second, and the absence of these complications in two others. In the fifth case, a hemorrhagic focus in the distal tip of the leiomyoma was not detected on MR images obtained 3 days before surgery. CONCLUSION: MR imaging is useful for the diagnosis and characterization of uterine leiomyomas that have prolapsed into the cervical or vaginal canal.

Adult↗
PubMed1984

The role of 17 beta-estradiol in the recovery from oviductal prolapse in layers.

Plasma 17 beta-estradiol concentrations, thecal estrogen content, and uterine prostaglandin synthetase activity were measured in healthy and prolapsed hens as well as in layers that recovered after exposure to low intensity lighting (250 or 50 lx). The effect of estradiol benzoate injections (100 ng, 3 X per week) in hens exposed to high intensity light (greater than 500 lx) was also studied. Prolapsed hens had significantly lower plasma 17 beta-estradiol concentrations (60 +/- 12 pg/ml; mean +/- SEM) than recovered (374 +/- 40 pg/ml) or healthy hens (475 +/- 45 pg/ml). Theca cells from recovered hens had a significantly higher content of 17 beta-estradiol (.7 ng/5 X 10(5) cells) than theca cells from normal or prolapsed birds (.3 ng/5 X 10(5) cells). Microsomes prepared from the uteri of prolapsed hens converted significantly less arachidonic acid to prostaglandin metabolites (4.4%) than did microsomes from healthy or recovered birds (9.0%). Treatment of prolapsed hens with estradiol benzoate resulted in 89% of the birds recovering within 3 weeks compared to a 4% recovery rate in the controls. We conclude that restoration of peripheral 17 beta-estradiol concentrations to normal levels was concomitant with recovery in prolapsed birds, and suggest that the estrogen exerts its effect by raising the level of prostaglandin synthetase activity in the uterus.

Animals↗
PubMed1999

Vaginal hysterectomy for correcting genital prolapse. Long-term evaluation.

OBJECTIVE: To determine whether a transvaginal hysterectomy with anterior and posterior repair is effective in the long term in treating uterovaginal prolapse and stress urinary incontinence (SUI). STUDY DESIGN: Seventy-four patients subjected to vaginal hysterectomy for the treatment of severe genital prolapse, on average five years before the study, were contacted by letter for evaluation. Four of these patients had died, and 47 (67.1%) responded to the letter. The mean age of the patients at the time of reevaluation was 66.1 +/- 10.6 years, and mean parity was 6.6 deliveries. RESULTS: All patients but two presented some degree of genital prolapse at the time of reevaluation, with three cases of total vaginal vault prolapse. White patients (87.2%) predominated over African (black) patients (12.8%). SUI associated with prolapse persisted in 14 of the 20 patients, and 6 others had this complaint after surgical correction (22.2% of previously continent patients). CONCLUSION: The rate of unsuccessful surgical correction of severe genital prolapse was very high (95.7%), and cure of SUI was low (30%), with SUI actually arising after surgical correction in 25% of continent patients. In addition to parity, there seems to be a racial factor linked to the onset and maintenance of this pathology, with a higher prevalence among white patients.

Aged↗
PubMed1999

[Posterior genital prolapse following the Burch method of colposuspension].

The aim of this paper was to know the prevalence of genital prolapse after the Burch procedure. Also to intend knowing if the associate surgery for vaginal relaxation used in our Urogynecologic Service is working well. Seventy four patients with more than six months after the Burch procedure were addressed from October 1995 to January 1996. Special attention was put to detect pelvis floor defects in specific vaginal sites (urethra, bladder, vaginal ápex, cul de sac and distal posterior wall). The prevalence of urethrocele was 2.7%, cystocele 50.6%, almost of all were mild. None severe cystocele was detected. Cervical prolapse was present in 21.3%, vault prolapse in 9.3% and enterocele 41.9%. The posterior colporraphy seems to be useful to prevent the vault prolapse and the enterocele. On the contrary the Moschowitz procedure seems not to be useful in this aspect. In order to diminish the prevalence of genital prolapse posterior to Burch procedure it would be better to improve the preoperative vaginal examination in order to do segmentary prolapse diagnosis and also to stablish an individualized surgical treatment of them.

Female↗
PubMed1999

[Interposition of a synthetic mesh by vaginal approach in the cure of genital prolapse].

There are two goals for treatment if vaginal prolapse, restauration of normal function and anatomy and prevention of recurrence. Most operations described for replacement and maintenance of prolapsed organs in the pelvic cavity do not treat the cause of the prolapse which is diastasis of levator muscles and, in most cases, failure of the pelvic fascia. By analogy with the treatment of parietal hernias, the concept of a synthetic graft to reinforce failing fascias and restauration of normal anatomy has been proposed. From June 1994 through March 1999, 46 patients were treated for genital prolapse by a vaginal approach with positioning of a polyester mesh sutured to the vaginal angles. No major complication was observed. One mesh exposure occurred 4 months after treatment of a cystocele with vaginal hysterectomy and was treated by partial resection with good outcome. With a 5-year follow-up (median 26 months), all patients are totally satisfied. No recurrence of prolapse was observed. Sexual function was preserved without dyspareunia. This study demonstrates the feasability and efficacy of using a synthetic graft in the cure via a vaginal approach of genital prolapse. Complementary studies are necessary to evaluate the indications for which the procedure can be proposed and how it should be integrated in to schemes with other procedures.

Female↗
PubMed2000

Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse.

PURPOSE: We determined the indications for anti-incontinence surgery in continent women undergoing surgical repair of severe urogenital prolapse. MATERIALS AND METHODS: We prospectively evaluated 24 continent women referred for evaluation of severe urogenital prolapse. All patients underwent a meticulous clinical evaluation, including a complete history and physical examination, urinary questionnaire, voiding diary, pad test, cotton swab test, video urodynamics and cystoscopy. The urodynamic evaluation was repeated with prolapse repositioning by a fitted vaginal pessary. Surgical intervention was tailored according to urodynamic findings. RESULTS: Reduction of prolpase with a pessary unmasked sphincteric incontinence in 14 women (58%). Ten women with no urodynamic evidence of sphincteric incontinence underwent anterior colporrhaphy and no additional anti-incontinence procedure was performed. Mean followup was 44 months (range 12 to 96). None had postoperative stress incontinence but 1 (10%) had a recurrent grade 2 cystocele. The 14 remaining women with sphincteric incontinence after prolapse reduction underwent anterior colporrhaphy with a pubovaginal sling procedure. Mean followup in these cases was 47 months (range 12 to 108). In 2 patients (14%) stress incontinence developed postoperatively and 1 (7%) had a recurrent grade 3 cystocele. The incidence of urge incontinence did not appear to be significantly influenced by either surgical intervention. Overall 12 patients had preoperative urge incontinence, of whom 9 (75%) had persistent urge incontinence postoperatively. In another woman new onset urge incontinence developed. CONCLUSIONS: Preoperative urodynamic evaluation with and without prolapse reduction is essential for making the correct diagnosis of masked stress incontinence in women with urogenital prolapse. The decision to perform a concomitant prophylactic anti-incontinence procedure should be tailored to individual urodynamic findings. Larger series and longer followup are needed to establish the most effective preventive procedure for this troublesome clinical problem.

Aged↗
PubMedDate not supplied

[Combined vaginal and laparoscopic surgical treatment of genito-urinary prolapse].

BACKGROUND: A new combined technique for vaginal prolapse and cystocele using minimal access surgery is presented and evaluated. METHODS: Thirty-five patients (mean age 57.1) with genitourinary prolapse (II-IV degree Baden-Walker) without urinary incontinence underwent surgery between January 98 and December 99 with 4-24 months of follow-up (mean 14.6 months). The surgical stages include total vaginal hysterectomy with bilateral adnexectomy, wide opening of the vagina without excessive removal of the vaginal mucosa; the bladder is loosened and the polypropylene mesh (PPM) is lightly fixed to the bladder and stitched to the anterior and posterior vaginal wall. The PPM is introduced into the abdomen and laparoscopically fixed to the sacral promontory with titanium spirals having checked vaginally the right tension of the mesh. Accurately laparoscopic peritonization of the PPM ends the surgical procedure. RESULTS: The operation time was 90'-140' (mean 112') followed by 3-7 days of hospitalization (mean 4.3). Vaginal prolapse and cystocele were corrected in all cases. No surgical complications, de novo urinary incontinence, prolapse recurrence or inconvenience to sexual activity have been observed. There was one erosion of the vaginal wall by the PPM 45 days after the operation. CONCLUSIONS: Initial studies suggest that laparoscopic sacrocolpopexy and cystocele repair with PPM is an effective treatment for genitourinary prolapse. If subsequent studies will confirm these findings, the development of minimal access techniques for genitourinary prolapse will represent a significant surgical advance.

Aged↗
PubMed2001

Transabdominal approach to repair of vaginal vault prolapse.

PURPOSE: To review the preoperative evaluation of women with vaginal vault prolapse and describe the surgical methods of treatment using a transabdominal approach. METHODS: Abdominal sacral colpopexy is the most widely performed method of transabdominal correction of vaginal vault prolapse. The procedure is completed by securing the apex to the vagina to the periosteum of the sacrum with mesh. This procedure is demonstrated in great detail. Successful repair can be achieved by other transabdominal approaches and by laparoscopic approaches. RESULTS: Twenty women (mean age 67.9 years) were evaluated for complex pelvic floor prolapse. Six (30.0%) patients had failed transvaginal sacrospinus ligament fixation. Abdominal sacrocolpopexy utilizing Marlex mesh, Halban culdeplasty, and paravaginal repair was performed on all patients. Five posterior repairs and one anterior repair was done. The average operating time for the colpopexy and enterocele repair alone is approximately 90 minutes. The average blood loss was 284 cc. The average hospital stay was 3.7 days. The mean follow-up is 11.3 months (6-27 months). The vaginal vault is well supported in all patients with no recurrent enterocele or vault prolapse. Three patients have asymptomatic grade II cystoceles, and three patients have asymptomatic grade II rectoceles. There were few complications. No mesh complications have been encountered. CONCLUSIONS: Vaginal vault prolapse can be a difficult problem to diagnose and treat. Successful treatment requires thorough knowledge of the anatomy, methods of diagnosis, and treatment options. The abdominal sacrocolpopexy achieves excellent correction of vaginal vault prolapse with minimal morbidity.

Abdomen↗
PubMed2001

Assessing and treating pelvic organ prolapse.

At least half of all women who have given birth experience pelvic organ prolapse, a condition where pelvic organs protrude through the vagina. Because of the presentation of the different aspects of prolapse, treatment had become compartmentalized in line with pelvic involvement, with urologists, gynecologists, colorectal surgeons, and gastroenterologists each addressing their field of expertise. In addition, urinary or fecal incontinence, urinary retention, and urinary tract infections often are associated with pelvic organ prolapse. Both pelvic organ prolapse and incontinence have a significant impact on the quality of life. New training programs in urogynecology and reconstructive pelvic surgery are producing clinicians who are better equipped to treat pelvic organ prolapse, as well as related urinary and fecal incontinence. This article provides an overview of the various aspects of pelvic organ prolapse for all clinicians involved in assessment, treatment, and potential prevention of this condition.

Female↗
PubMed2002

Pelvic organ prolapse and connective tissue abnormalities in Korean women.

OBJECTIVE: To evaluate the relationship between pelvic organ prolapse in Korean women and joint hypermobility, which suggests a metabolic collagen fiber abnormality. STUDY DESIGN: Between March 1998 and March 2000, we investigated 55 patients with prolapse. The prevalence of joint hypermobility, by measuring finger extension angle, and the proportion of patients with joint hypermobility were measured in patients with pelvic organ prolapse and benign gynecologic patients (control group). RESULTS: In middle-aged women (40-59 years), the average finger extension angles were higher in the POP group than in the control group (50.04 +/- 9.70 degrees vs. 39.50 +/- 12.19 degrees, respectively; P < .05), but in older women there was no significant difference between the two groups (42.84 +/- 13.05 degrees vs. 43.00 +/- 13.34 degrees, respectively; P > .05). CONCLUSION: The prevalence of joint hypermobility was higher in the POP group and with advanced POP stage (III, IV) than in the control group and early POP stage (I, II). Our results suggest that intrinsic connective tissue abnormality is related to the development of pelvic organ prolapse. Further study involving more patients with pelvic organ prolapse is warranted, and molecular studies to determine the genetic basis of pelvic organ prolapse are also required to further elucidate this abnormality.

Adult↗