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PubMed1989

Echocardiographic features of mitral valve prolapse in Libyan patients.

Echocardiographic observations in 200 subjects with mitral valve prolapse (MVP) are presented. The diagnostic criteria used were: (1) abrupt late systolic posterior motion of one or both leaflets of the mitral valve, and (2) holoor pansystolic posterior motion of 3 mm of one or both leaflets of the mitral valve. Most of the subjects were young--72% were aged less than 30 years. Prolapse of posterior leaflets was noted in 98% of subjects--69.5% late systolic, 28.5% pansystolic, and 2% had prolapse of the anterior mitral leaflet only. Mitral valve prolapse was considered to be primary--being the only abnormality in 78.5% of the subjects. In the remaining 21.5% MVP was associated with other cardiac lesions, the commonest being, atrial septal defect (2.5%), dilated aortic root (2%), bicuspid aortic valve (2%), cardiomyopathy (5%), rheumatic heart disease (4%) and ischaemic heart disease (1.5%). Mitral valve prolapse was considered to be important enough to result in haemodynamically significant mitral regurgitation in only 8% of subjects. Mitral valve prolapse was the commonest single echocardiographic abnormality (16%) observed in patients referred to this university hospital, which is the referral centre for approximately half of Libya. Although this does not indicate the prevalence of MVP in the general population, this study indicates MVP to be the commonest valvular abnormality seen in hospital practice in Libya.

Adolescent↗
PubMed1988

Mitral valve billowing and prolapse: perspective at 25 years.

The syndrome of primary mitral leaflet billow, with or without prolapse, is associated with myxomatous degeneration of the mitral valve apparatus, mainly the posterior leaflet, and the syndrome may be familial. It manifests clinically with an isolated nonejection systolic click (billow), a murmur of mitral regurgitation that is usually late systolic (prolapse), or a combination of murmur and click. Echocardiography identifies and assesses the extent of the billowing of mitral leaflet bodies but there are no specific echocardiographic criteria that can differentiate normal from pathological billowing. Similarly, a prolapsed leaflet is not detected echocardiographically when there is localized and mild failure of leaflet edge apposition but a more severely prolapsed, or flail, leaflet can be demonstrated and confirmed by that technique. Symptoms of the syndrome include anxiety, chest pain and palpitations. The resting electrocardiogram may show ST segment and T wave abnormalities. The majority of patients have a benign course and require reassurance only. Complications include systemic emboli, infective endocarditis, progression to severe mitral regurgitation, arrhythmias and, rarely, sudden death. Patients with prolapse of a leaflet edge are more likely to develop complications than those with only billowing of the leaflet bodies. Surgery, preferably valvuloplasty, is required for severe regurgitation and may also be indicated for potentially lethal tachyarrhythmias unresponsive to medical therapy. Mitral leaflet billow and prolapse may be secondary to, or associated with, many conditions. The prognosis is then principally that of the underlying disease of which ischemic heart disease and hypertrophic cardiomyopathy are the most important.

Death, Sudden↗
PubMed1986

[Syndrome of mitral valve prolapse: past, present and prospects].

A short history of mitral valve prolapse was reviewed to learn what was the knowledge we have and to recognize what should be resolved at the present time and in the near future. Particular emphasis was placed on the detailed studies performed in Japan as compared to those of occidental countries. Prevalence of mitral valve prolapse largely depends on the methods of investigation and is definitely related to the diagnostic criteria. Among those, the echocardiographic criteria are particularly important, but there are pitfalls which cause over- or underdiagnosis. Auscultatory criteria, which should be confirmed by phonocardiography, are not sensitive enough because of the presence of "silent" prolapse, though the auscultatory acumen of the averaged doctors is quite often unexpected. DaCosta syndrome and the related conditions have some connections with mitral valve prolapse syndrome. The relation should extensively be studied, because somatic and mental signs are not conclusively related to the anatomical abnormalities and the cases with borderline prolapse tend to have definite signs and symptoms. Natural course of mitral valve prolapse based on the long follow-up study is far from the conclusion. So far, no comprehensive cases with well-known natural history of this entity. Prognosis should be carefully evaluated, because most of the patients are doing well and several ominous prognostic signs, such as sudden deaths, are thought to be overemphasized.

Echocardiography↗
PubMed1988

[Two cases of strangulated urethral prolapse].

This is a report of two cases of strangulated urethral prolapse we recently experienced. One patient, a 70-year-old woman, was admitted to our hospital because of dysuria, painful urination, genital mass (phi 3.0 cm) and bleeding. The other patient, 54 years old, visited our department complaining of pain on urination, and genital mass (phi 2.0 cm) and bleeding. Surgical excision was performed for these prolapsed urethra, and in pathological findings, vascular dilation, blood congestion and partial thromboformation were recognized. Their postoperative course was uneventful without recurrence or abnormal urination. Urethral prolapse is defined as the circular eversion of the urethral mucosa through the external meatus. This condition is a relatively uncommon lesion in the literature, but is a common clinical entity in postmenopausal women and prepubertal girls. Most of the urethral prolapses are small and asymptomatic, but if the prolapsed urethra is large, the mass becomes strangulated, and urinary symptoms, pain and bleeding are present. For the treatment of the urethral prolapse, surgical excision has been widely practiced and is successful.

Aged↗
PubMed1986

Mitral valve prolapse in patients with anorexia nervosa and bulimia.

We studied 43 consecutive individuals with eating disorders (anorexia nervosa and/or bulimia) for the presence of mitral valve prolapse and/or cardiac arrhythmias by physical examination, M-mode and two-dimensional echocardiography, and 24-hour continuous ambulatory electrocardiographic monitoring. Ten of the 43 had findings of mitral valve prolapse on resting cardiac auscultation. Echocardiographic evaluation confirmed the diagnosis of mitral valve prolapse in these ten as well as in six other individuals, giving an overall incidence of 37% (16/43). Similar echocardiographic findings were present in only 4% (1/23) of control individuals. Cardiac arrhythmias other than benign isolated premature extrasystoles were noted in five patients with eating disorder; all five also had echocardiographic findings of mitral valve prolapse. The incidence of mitral valve prolapse appears to be increased in patients with eating disorders. In addition, the arrhythmogenic effects of mitral valve prolapse may present an additional risk factor in these patients.

Adolescent↗
PubMed1987

Tricuspid valve prolapse.

Tricuspid valve prolapse is an infrequent echocardiographic finding that is most commonly associated with mitral valve prolapse. When compared with patients exhibiting isolated prolapse of the mitral valve, patients with tricuspid valve prolapse are somewhat older individuals with a slightly higher frequency of neurologic symptoms, fatigue, weakness, supraventricular arrhythmias (especially atrial fibrillation) and skeletal deformities. Tricuspid valve prolapse may serve as a marker of more-diffuse connective tissue abnormalities, and its identification also should prompt an echocardiographic search for evidence of prolapse and regurgitation of the other heart valves.

Adult↗
PubMed1987

Treatment of rectal prolapse. A clinical study of 50 consecutive patients.

The results of surgical treatment of rectal prolapse in 50 consecutive adult patients were evaluated. The mean age of the patients was 51.8 +/- 15.9 years. 8 of the patients were males. 13 of the patients had recurrent prolapse after operations performed earlier elsewhere. There were 4 types of operations: Delorme's mucosal sleeve resection (n = 21), perineal rectosigmoidectomy (n = 7), low anterior resection (n = 12) and abdominal rectopexy (n = 10). There was no operative mortality. The main postoperative complications were perforation or stricture of the rectum in the Delorme group and ileus and anastomotic complications in the low anterior resection group. The frequency of postoperative complications was clearly highest in the low anterior resection group (67%). Follow-up examination was performed 5.2 +/- 3.9 years postoperatively. The recurrence rate of prolapse was highest after perineal operations. Fecal incontinence was almost always associated with recurrence of prolapse and its incidence increased with reoperation. In conclusion, abdominal rectopexy was superior to other forms of operation in the treatment of rectal prolapse. Successfull correction of rectal prolapse does not necessarily rule out the need for later surgery for faecal incontinence.

Adult↗
PubMed1986

[Two-dimensional echocardiographic criteria in diagnosing mitral valve prolapse].

Diagnostic accuracy and reproducibility of the two-dimensional echocardiographic criteria for mitral valve prolapse were evaluated in 68 cases with phonocardiographic features of mitral valve prolapse. Intraobserver difference for the diagnosis of mitral valve prolapse was also evaluated by reviewing the same videotapes from these 68 cases on two different occasions (five years apart). Of 45 cases who had been interpreted as having anterior leaflet prolapse, the same interpretation was made in 37 cases (82.2%), involvement of the posterior leaflet was suggested in four cases, and prolapsing leaflets were not identified in four cases. Of 21 cases with anterior and posterior leaflets prolapse, the diagnosis agreed in only 13 cases (61.9%). The follow-up echocardiography performed in the mean period of three years revealed the reproducible findings in 19 of 20 cases.

Echocardiography↗
PubMed1984

Klinefelter's syndrome and mitral valve prolapse. an echocardiographic study in twenty-two patients.

It is well known that the incidence of mitral valve prolapse is increased in various hereditary and humoral disorders, particularly in diseases with abnormal collagene structure and metabolism. We consecutively investigated, both clinically and echocardiographically, 22 patients with Klinefelter's syndrome (Mean age: 35 +/- 15.8 years). On clinical examination one third (7 patients) showed clinical signs of connective tissue weakness, 9 patients were obese. In 3 patients without a history of rheumatic fever mitral regurgitation was present. A mid-systolic click was heard in 12 patients, in 8 of them a click-murmur syndrome. Mitral regurgitation has been found in 3 patients. Echocardiographic ally, 12 of 22 patients (55%) revealed mitral valve prolapse which was not correlated with the degree of the chromosomal aberration. The incidence of mitral valve prolapse in an otherwise healthy male population is reported to be approximately 6%. Thus, in Klinefelter's syndrome, the frequency of mitral valve prolapse is found to be markedly increased. Regarding the nosological implications of mitral valve prolapse, it is recommended to thoroughly examine patients cardiologically. Furthermore, since mitral valve prolapse bears a higher risk of malignant cardiac arrhythmias, chest pain and endocarditis, an antiarrhythmic treatment and--if indicated--antibiotic prophylaxis has to be instituted. Those patients also should be advised to adjust their life style appropriately.

Adolescent↗
PubMed1982

Linear cauterization for the treatment of rectal prolapse in infants and children.

Rectal prolapse in pediatric patients has different anatomic causative and, hence, therapeutic significance from prolapse or procidentia encountered in adults. Medical management successfully relieves prolapse in a large percentage of pediatric patients. Seventy-three patients in whom the correction of rectal prolapse by medical management failed underwent linear cauterization of the anorectum. Seventy-one were treated successfully. Five children had an additional cauterization for the permanent relief of rectal prolapse. One patient required an additional extensive operation to prevent recurrence. This successful method of managing rectal prolapse has been associated with a low morbidity rate and should be considered before attempting more complex alternative surgical procedures.

Child↗
PubMed1982

Medical treatment of urethral prolapse in children.

Urethral prolapse denotes the complete circular eversion of the urethral mucosa through the external meatus. Two different entities exist: premenarcheal and menopausal urethral prolapse. Premenarcheal prolapse is predominantly asymptomatic and is usually brought to medical attention by vaginal bleeding. Trauma and medical conditions predisposing a patient to increased abdominal pressure are associated with prolapse in children. The menopausal group seeks medical attention primary because of the severity of urinary symptoms, ie, nocturia, urgency, tenesmus, dysuria, and frequency. Therapy for both groups has been traditionally accomplished by surgical manipulation-excision, surgical ligation, cautery, fulguration, and cryosurgery. The authors treated 5 premenarcheal female children with antibiotics, estrogen cream, and sitz baths for 2 weeks. In all the patients prolapse was resolved. The results, with follow-up for 4 to 12 months without recurrence, suggest that urethral prolapse in children can be managed without surgical intervention.

Child↗
PubMed1981

Infective endocarditis and mitral prolapse: a comparison with other types of endocarditis.

We compared clinical features, response to therapy, and outcome of infective endocarditis in ten patients with mitral valve prolapse and 23 patients with endocarditis involving other types of left-sided valvular lesions. Signs of endocarditis were more subtle in patients with mitral valve prolapse, and antimicrobial therapy was instituted later in those patients. Nevertheless, nine of ten patients with mitral valve prolapse and endocarditis responded optimally to antimicrobials; only five of 23 patients with other types of endocarditis responded similarly. Four patients with mitral valve prolapse experienced increasing valvular dysfunction during the year after treatment of endocarditis; one died. We conclude that endocarditis in patients with mitral valve prolapse is more responsive to antimicrobial therapy even though recognition of the infection often is delayed. However, mitral valve prolapse endocarditis is not a benign infection, because progressive valvular dysfunction is a frequent sequel.

Adolescent↗
PubMed1980

[Genital prolapse and ureteropelvic distension].

In the last 110 cases of genital prolapse examined, IVU formed part of the prior urological investigation. 14 cases of ureteropelvic distension were thus discovered (13.6% of cases). In ten cases the prolapse was sufficiently largee as to exterioris the uterus or bring it to of the vulva. In 13 cases out of 15 a larg cystocoele was visible at the vulva with a full bladder. The precise urological consequences of these prolapses was greater than had been expected: 13 cases of incomplete vesical retention, 4 of unilateral ureteropelvic distension and 10 bilateral, including 3 only symmetrical. Bilateral high distension was in general associated with a large cystocoele. Severe renal insufficiency was seen in only one case, and 5 moderate elevations in blood urea, in 5 cases. The mechanism of such ureteropelvicalyceal distension is not clear, but the prolapse is directly responsible, since mechanical (insertion of a pessary) or surgical reduction of the prolapse restores the upper excretory tract to normal. Renal function recovered all the more rapidly when the prolapse had been present for a shorter time.

Aged↗
PubMed1995

[Operative procedures for mitral prolapse and its clinical results].

Mitral valve plasty is the very important procedure for treatment of mitral regurgitation from the view point of post operative quality of life because patients may be possible to be free from postoperative drug therapy especially when the normal sinus rhythm is restored even if the concomitant maze procedure is necessary. In this report, 36 patients who underwent mitral valve plasty for mitral regurgitation were evaluated. In 18 patients who had posterior leaflet prolapse, McGoon's procedure was performed. Two of them required secondary mitral valve replacement 4 days after operation. Reoperation disclosed tissue detachment at the mitral annulus sutures which were not reinforced by a ring. It was considered that annular ring plasty is preferable after resection of prolapsed posterior leaflet by McGoon's procedure. Out of 18 patients who had mitral valve prolapse including anterior leaflet, 8 patients underwent such conventional procedures as transfer of chordae tendinae, leaflet resection and shortening of chordae. Four patients resulted in second look mitral valve replacement 11 days to 1 month after mitral valve plasty. On the contrary, the clinical results of repair of chordae tendineae with artificial chordae of extended polytetrafluoroethylene (ePTFE) were good. It is concluded that the resection of prolapsed leaflet and reconstruction of the annulus with reinforcement using a prosthetic ring is preferable for the posterior leaflet prolapse. For the anterior leaflet prolapse, good results can be obtained by replacement of chordae tendineae with ePTFE sutures.

Adolescent↗
PubMed1995

Utero-vaginal prolapse: a rural disability of the young.

A study consisting of 156 and 195 patients admitted to Gondar College and Gandhi Memorial hospitals respectively, for surgical corrections of vaginouterine prolapses of second and third degrees was carried out from June 1989 to June 1993. At Gondar, uterovaginal prolapses accounted for 19.9% of all major gynaecological operations in comparison to 17.2% at Gandhi. The mean ages for Gondar and Gandhi subjects were 38.09 +/- 11.52 and 42.17 +/- 13.16 years, respectively. In both centres there is statistically significant (p < 0.05) sequestration of especially third degree prolapse with increase in age. Mean parity of 5.6 +/- 2.7 children and 5.4 +/- 2.6 children have been obtained for Gondar and Gandhi groups, respectively. There is statistically significant increase (p < 0.05) of the second and more so of the third degree genito- urinary prolapse with increase in parity. Of the 125 housewives from the Gondar group, 114 (92.2%) were from the rural areas. The results of Gandhi group revealed that 143 (90.5%) out of 158 subjects were rural housewives. There is significant association of prolapse and occupation particularly with the rural housewives of both centres. The symptoms and signs of both centres were variable and dependent on degrees of prolapse; and the mean durations were 2.8 years +/- 2.9 years for Gondar and 2.4 years +/- 2.4 years for Gandhi, respectively. As a vaginal problem, vaginal surgical approaches yielded better results despite shortcomings of short term follow up. This paper based on two hospital records with similar results illustrates that it is mainly a rural problem and relatively of a younger population.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Rectal prolapse: etiopathogenetic and therapeutic problems in psychiatric patients].

Rectum prolapse is a pathological condition which has long been considered as rare but whose occurrence has been progressively increasing in the past decades. There still exists a degree of uncertainty as to the disease etiopathology: moreover the exact relationship between rectum prolapse and psychic disorders which have been found in up to 50% of the patients with prolapse has not been clarified. Neither on the therapeutic level is there a common opinion as to the ideal surgical approach and over one hundred techniques have been suggested for the surgical correction of the prolapse. A study has been carried out on 10 patients suffering from psychiatric pathology of different kinds (oligophrenia, schizophrenic psychosis), hospitalized at Istituti Ospedalieri Opera Don Uva in Bisceglie. They suffered from complete rectum prolapse and underwent surgical intervention. In this study the etiopathogenetic problems of prolapse are investigated according to recent developments, with particular reference to the very peculiar implications they have in the psychiatric patient. Finally the surgical techniques correctly used and their possible application in the psychiatric patient are examined.

Adult↗
PubMed1994

Prolapse of the sigmoid neovagina: report of three cases.

BACKGROUND: Prolapse of a sigmoid neovagina, created in patients with congenital vaginal aplasia or male transsexualism, is rare. In correcting this condition, preservation of coital function and restoration of the vaginal axis should be of primary interest. CASES: One patient with Mayer-Rokitansky-Küster syndrome developed a protrusion of the sigmoid neovagina almost 4 years after the initial operation. The prolapse was treated successfully using an abdominal approach to suspend the neovagina to a Cooper ligament. The second patient is a male-to-female transsexual who developed a prolapse 3 years after the creation of a sigmoid neovagina. After suspension of the neovagina to a Cooper ligament, the prolapse recurred; in a repeat approach, the neovagina was successfully suspended to the sacral promontory. The third patient, with Mayer-Rokitansky-Küster syndrome, complained of a protrusion immediately after creation of the neovagina. Initially, the redundant sigmoid was resected vaginally. However, the prolapse recurred, and an abdominal suspension to a Cooper ligament was performed. Finally, after 1 year, another recurrence was treated successfully with a vaginal approach. CONCLUSION: Prolapse of an artificially created vagina is a rare occurrence, without a standard treatment. Both abdominal and vaginal approaches may be needed to restore the neovagina without compromising its function.

Adolescent↗
PubMed1993

[Pathology and histochemistry of mitral valve prolapse].

UNLABELLED: To analyze the myxomatous changes and the components of acidic glycosaminoglycans (GAG) of the mitral valve in aged patients with the mitral valve prolapse (MVP) syndrome, a pathological and histochemical study was performed on hearts of 18 autopsied cases with MVP. The histochemical study included toluidine blue Ohno's method, and 3 enzymatic digestion tests with streptomyces hyaluronidase, chondroitinase AC-II and chondroitinase ABC. The following results were obtained: 1. The incidence of MVP with mitral regurgitation among 2,060 elderly autopsy patients over 60 years of age was 0.87%. 2. PATHOLOGICAL FINDINGS: marked prolapse was detected in the anterior leaflet of 3 patients, moderate prolapse in the anterior leaflet of 6 and moderate prolapse in the posterior leaflet of 5. Most patients showed greater prolapse in the anterior than in the posterior leaflets. The MVP of 11 patients (61%) was associated with tricuspid valve prolapse. 3. Histological findings: All cases exhibited thickening at the rough zone; 17 patients showed enlargement of the spongiosa layer, and 15 showed a decrease or disappearance of the fibrosa layer. All cases showed various degrees of change in the atrialis layer. The main site of myxomatous change in the mitral valve of MVP was the spongiosa layer of the rough zone. 4. Histochemical findings: Results using 3 methods of enzymatic digestion tests were positive in 13 patients, which suggested that the major component of increased GAG at the myxomatous changes in the mitral valve of MVP was hyaluronic acid, as did the results with Ohno's toluidine blue method.

Aged↗