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PubMed1995

Histopathologic studies of innervation of normal and prolapsed human mitral valves.

We evaluated the distribution of the nerves in valve tissue of humans to clarify the relationship between mitral valve prolapse and autonomic nerve dysfunction. We studied 15 autopsy specimens of normal mitral valve, 10 prolapsed mitral valves, five each of normal tricuspid, aortic, and pulmonary valves, and three prolapsed mitral valves obtained at cardiac surgery. Immunohistochemical studies utilized the avidinbiotin peroxidase complex (ABC) method and several nerve-related antigens: 1) S-100 protein, glial fibrillary acidic protein (GFAP), and neurofilament protein (NFP) as markers of glial and Schwann cells of the nervous system; 2) choline acetyltransferase (ChAT) to identify cholinergic nerve endings; 3) neuropeptide Y (NPY), a neuropeptide that is distributed in accordance with sympathetic nerves; and 4) calcitonin gene-related peptide (CGRP), a neuropeptide that is distributed in accordance with afferent nerves. Distribution of adrenergic nerve fibers was also examined by fluorescence method. Morphology of nerve endings of the normal mitral valve was studied by electron microscopy. In normal valves, distributions of S-100 protein, GFAP, and NFP immunoreactivities were clearly visible along the subendocardial site on the coaptation aspect of the base-to-body portion of each valve, regardless of the kind of valve. In contrast, there was only a scanty distribution of these reactivities on the physiologic coaptation area of the tip. In prolapsed mitral valves, there was no distribution of S-100-positive protein or other nerve-related antigens in areas of the valve with myxomatous degeneration. Distribution of CGRP, ChAT, and NPY immunoreactivities, and adrenergic fluorescence, were the same as those of the nerve-related antigens in both normal and prolapsed mitral valves. Electron microscopic study of the atrial aspect of normal mitral valves revealed numerous small axons with aggregations of small clear vesicles, indicating cholinergic features. The results suggest that the subendocardial site on the atrial aspect at the middle portion of the mitral valve is rich in nerve endings, including the afferent nerves, and that mechanical stimuli from this area caused by abnormal coaptation in mitral valve prolapse may produce an improper circuit in autonomic nerve function between the central and mitral valve nervous systems.

Adult↗
PubMed1997

Results of perineal procedures for the treatment of rectal prolapse.

The optimal surgical procedure for the management of rectal prolapse is still under debate. Therefore, the aim of this study was to evaluate the short-term outcome of perineal procedures in patients with rectal prolapse. Between April 1989 and April 1995, all consecutive patients at the Cleveland Clinic Florida who underwent Delorme's procedure or perineal rectosigmoidectomy with or without levatoroplasty for full-thickness rectal prolapse were evaluated. Clinical and physiological assessments were performed before and after surgery. A standard continence scoring system, based on the frequency and type of incontinence (0 = full continence, 20 = complete incontinence) was used to assess the results of each procedure. Additionally, morbidity and mortality, and clinical and functional outcomes were evaluated. Sixty-one patients underwent perineal procedures for rectal prolapse; 16 patients died from comorbid conditions after undergoing postoperative physiologic assessment. These 55 females and 6 males, with a mean age of 75 (range, 48-101) years were studied. Patients were followed up for 27.2 (6-72) months, and mean prolapse duration was 4.2 (0.2-30) years. Although mean preoperative incontinence score was 15.9 (8-20), it was 6.3 (range, 0-12) in postoperative course. Mean resection length of rectosigmoid was 23.3 (3-71) cm, and in these patients, two (3.3%) coloanal anastomotic leaks and four (6.5%) anastomotic strictures were observed. There was one postoperative death. There were statistically significant differences among the groups relative to short-term recurrence rates, postoperative incontinence scores, mean resection length, coloanal anastomotic stricture, and leak (P< 0.001). However, pre- and postoperative anal manometry did not reveal statistically significant changes (P > 0.05) in each group or among the groups. Perineal procedures were found to be safe and effective in eradicating rectal prolapse and improving fecal incontinence in the elderly.

Aged↗
PubMed1997

Cervical prolapse complicating pregnancy.

Uterine cervical prolapse concurrent with pregnancy is rare. This article reports three cases of second-degree cervical prolapse during pregnancy. Two women developed prolapse in the late second trimester while one women had preexisting prolapse. Both women with prolapse developing during midpregnancy were treated unsuccessfully with a vaginal pessary to maintain cervical placement. Premature labor occurred in both of these women, resulting in one preterm birth. Although cervical prolapse is rarely encountered in pregnancy, the threat of preterm labor and delivery warrants close observation.

Adult↗
PubMed1998

Treatment of anterior mitral leaflet prolapse: chordal suture plication and free-edge remodeling in 34 patients.

In this study are considered the short-middle term results of anterior mitral leaflet prolapse repair obtained by means of a personal operative technique: chordal shortening and free edge remodeling. In our institution since 1993 34 consecutive patients with degenerative myxomatous mitral regurgitation, (mean age 63.3 years, range 25 to 83 years), underwent surgery. Before the operation 22 patients (64.7%) were in NYHA functional class III or IV. Mitral insufficiency, evaluated by echocardiogram, was severe in all patients; a prolapse of only anterior leaflet was present in 10 patients, both leaflets prolapsed in the others. Patients with chordal rupture of anterior mitral leaflet were excluded. Anterior mitral leaflet prolapse repair was performed with two continuous sutures including the free edge as well as the chordae for a variable length (2 mm up to 5 mm) depending on the degree of the elongation. A concomitant posterior leaflet quadrangular resection was performed in 24 patients (70.5%), and the procedure was almost always completed by a posterior suture annuloplasty reinforced by a glutaraldehyde-tanned strip of autologous pericardium. There were no perioperative deaths. The postoperative course was uneventful in all cases, and there were no hospital deaths. Postoperative echocardiographic evaluation showed satisfactory valve function. The mean valvular regurgitation before surgical procedure was 3.67 +/- 0.4, after repair 0.30 +/- 0.5 (p < 0.01). Follow-up was completed in all patients (mean 16.5 months) with no late deaths. One patient required early reoperation for recurrent mitral regurgitation resulting for a recurring anterior leaflet prolapse. We conclude that this technique is a safe, effective and easy procedure for the repair of anterior mitral leaflet prolapse without rupture. Nevertheless, a larger number of patients and a longer follow-up are required to confirm our results.

Adult↗
PubMed1998

Aortic cusp prolapse in ventricular septal defect and its association with aortic regurgitation--appropriate timing of surgical repair and outcomes.

OBJECTIVES: To determine the appropriate indications and timing for surgery in children with either a perimembranous or a subarterial type of ventricular septal defect (VSD) associated with aortic cusp prolapse. DESIGN: Retrospective review of children with VSD and associated aortic cusp prolapse with or without aortic regurgitation. This review was based on data obtained from clinical findings, two-dimensional echocardiography, cardiac catheterization and angiocardiography. SETTING: Tertiary health care facility with two-dimensional and colour Doppler echocardiographic and cardiac surgery facilities, and a catheterization laboratory. PATIENTS: Forty-eight patients were found to have perimembranous or subarterial VSDs in association with aortic cusp prolapse with or without aortic regurgitation. INTERVENTIONS: All 48 patients had high resolution two-dimensional and colour Doppler echocardiography. Of the 19 patients who underwent surgical closure of their VSD, five also had an aortic valvuloplasty and one had an aortic valve replacement. Cardiac catheterization was performed in 16 of the 19 surgical patients and 12 of the 29 nonsurgical patients. MEASUREMENTS AND MAIN RESULTS: Annual clinical and echocardiographic assessments in the nonsurgical group did not demonstrate increasing aortic insufficiency. Two children in the nonsurgical group showed spontaneous resolution of aortic insufficiency. In the surgical group, four children with VSD and clinical aortic insufficiency had surgery at less than five years of age; two were found to be regurgitant-free, one had trivial clinical aortic insufficiency and the other had echocardiography-only insufficiency. Of the seven surgical patients older than five years with VSD and clinical aortic insufficiency, four were found to be regurgitant-free, one had echocardiography-only regurgitation and two were unchanged. Two children undergoing surgery with VSD and no aortic insufficiency had postoperative echocardiography-only regurgitation, presumably related to cusp deformity from presurgical prolapse. Children with large VSDs with or without aortic cusp prolapse required surgery for indications of shunt size and pulmonary resistance. CONCLUSIONS: For children with small perimembranous VSDs and cusp prolapse, surgery is indicated only if there is clinical evidence of aortic regurgitation and progressive left ventricular enlargement.

Aortic Valve Insufficiency↗
PubMed1995

Genitourinary prolapse and joint hypermobility in women.

OBJECTIVE: To determine whether joint hypermobility, a clinical marker for connective tissue abnormalities, is associated with genital prolapse. METHODS: One hundred seven women were recruited from a university gynecology clinic. Subjects were examined in the standing and nonstraining positions for cystocele, rectocele, and uterine or vault prolapse. The degree of prolapse was graded 0-3. A separate investigator, blinded to the results of the gynecologic examination and using accepted criteria, evaluated each subject for joint hypermobility. RESULTS: Clinical joint hypermobility was found in 39 of 107 (36%) study patients. Subjects with joint hypermobility had a significantly higher prevalence of cystocele (33 of 37 [89%] versus 40 of 69 [58%], P = .001), rectocele (32 of 38 [84%] versus 33 of 69 [48%], P = .0002), and uterine or vault prolapse (25 of 38 [66%] versus 20 of 69 [29%], P = .0002) compared to women with normal joint mobility, respectively. No differences in the prevalence of stress incontinence were found between the two groups. CONCLUSION: Women with joint hypermobility have a significantly higher prevalence of genital prolapse compared to women with normal mobility, which suggests an underlying connective tissue abnormality as one etiology of pelvic relaxation.

Adult↗
PubMed1997

Patterns of prolapse in women with symptoms of pelvic floor weakness: assessment with MR imaging.

PURPOSE: To show the magnetic resonance (MR) imaging patterns of prolapse and to correlate them with symptoms in patients with constipation or fecal incontinence. MATERIALS AND METHODS: Thirty women underwent MR imaging with fast spoiled gradient-recalled acquisition in the steady state. The women were divided into three groups: 10 were asymptomatic volunteers, 10 had constipation, and 10 had fecal incontinence. Visceral prolapse and the configuration of the pelvic floor muscles were identified at rest and during straining. Visceral descent was compared between the three groups. RESULTS: Visceral prolapse was seen at multiple sites, most frequently in constipated patients. There was significantly greater bladder base descent (P < .01), uterocervical descent (P < .001), and puborectalis muscle ballooning (P < .05) in the group of constipated patients when compared with the group with fecal incontinence or the asymptomatic group. The degree of anorectal junction descent was significantly greater (P < .05) in the group of incontinent patients when compared with the asymptomatic group. CONCLUSION: MR imaging clearly shows pelvic visceral prolapse and pelvic floor configuration on straining. Prolapse frequently involves multiple sites in constipated patients, which is suggestive of global pelvic floor weakness. In contrast, the weakness is frequently posterior in fecally incontinent patients.

Adult↗
PubMed1992

[Valvular prolapse in autosomal dominant polycystic kidney].

BACKGROUND: The involvement of the cardiovascular system in hereditary connective tissue disorders has been known for a long time and produces abnormalities that usually affect valves and arterial walls. Valvular diseases in typical autosomal dominant illnesses such as polycystic kidney (PK) have recently been reported. METHODS: To test the prevalence of valvular prolapses in this disease, we studied [with clinical, chest x-ray, electrocardiographic, and echocardiographic (monobidimensional and Doppler) examination] 21 subjects with PK (Group A) and 34 unaffected relatives (Group B). 36 subjects comparable in sex, age, blood pressure, body build and renal function, with other kinds of kidney diseases, were the control group (Group C). RESULTS: In group A, 7 subjects (33.3%) were found affected by mitral valve prolapse (MVP), of whom 3 also had mitral incompetence, 4 tricuspid valve prolapse and 2 aortic cusp prolapse with mild valvular insufficiency. Another 2 patients had evidence of mitral and aortic incompetence, respectively, without valvular prolapse, annulus ectasia or morphological features of a rheumatic valvular disease. In Group B, 8 subjects (23.5%) had MVP; In Group C, MVP was seen in only 1 patient (2.7%) and aortic incompetence in one other. Statistical analysis confirmed the significance of the greater prevalence of MVP in group A and B in comparison with group C (p < 0.01). CONCLUSIONS: The high prevalence of valvular abnormalities in autosomal dominant PK suggests a common genetic disorder producing a defect in the extracellular matrix. An alternative hypothesis is that of two discrete yet adjacent genes.

Adolescent↗
PubMed1975

Prolapse of the posterior leaflet of the mitral valve associated with secundum atrial septal defect.

The association of prolapse of the posterior leaflet of the mitral valve with secundum atrial septal defect has recently been reported but the prevalence and features of this association have not been defined. Analysis of left ventricular cineangiograms in 54 patients have secundum atrial septal defect revealed evidence of prolapse of the posterior leaflet of the mitral valve in 20 (37 percent). In 11 patients (20 percent) there was clinical evidence of a mitral valve lesion (pansystolic murmur in 9 patients and mid-systolic click in 2 patients, 1 of whom also had a late systolic murmur); the remaining 9 patients had no auscultatory evidence of a mitral valve lesion. Thus, the incidence of clinically silent prolapse in association with secundum atrial septal defect was 17 percent (9 of 54 patients). Analysis of the angiographic findings revealed that the prolapse was triscalloped in 4 patients, biscalloped in 11 and uniscalloped in 5. Mitral regurgitation was present in 12, including the 11 patients with clinical signs of a mitral lesion. Three patients with moderate or severe mitral regurgitation had triscalloped prolapse. The association of prolapse of the posterior leaflet of the mitral valve with secundum atrial septal defect is common and may be present in the absence of any clinical evidence of a mitral valve lesion.

Adult↗
PubMed1976

Double mitral leaflet prolapse: echocardiographic-phonocardiographic correlation.

Ten per cent of all patients referred to the echocardiography laboratory for diagnostic evaluation had mitral valve prolapse. Of these 35 patients, 19 (54 per cent) had prolapse of both the anterior and posterior mitral leaflets. Of the 19 patients, 13 had Type A or midsystolic prolapse, whereas six had Type B or pansystolic prolapse of the mitral leaflets. Simultaneous phonocardiographic examination of the patients revealed either midsystolic click and late systolic murmur, pansystolic murmur, or isolated click and short systolic murmur. There was no apparent correlation between the echocardiographic prolapse pattern and the auscultatory events. One patient with Type A prolapse had no auscultatory abnormalities at the time of the examination. It is suggested that the abnormal sounds may be generated by a redundant mitral leaflet rather than chordae tendineae.

Echocardiography↗
PubMed1976

Dermatoglyphic patterns in patients with mitral valve prolapse: a clue to pathogenesis.

Fingerprints were obtained from 100 patients with mitral valve prolapse and compared with those of 100 control subjects matched for sex and race. Arches were found in 16.8 percent of all digital patterns in patients with mitral valve prolapse but in only 2.5 percent of all digits in the control group. Whereas no patient in the control group had four or more arches, 19 percent of patients with mitral valve prolapse had this finding. In addition, arches were found on 16 and 9 percent, respectively, of digits IV and V in patients with mitral valve prolapse but were not found on these digits in the control group. The finding of four or more arches or arches on digits IV or V may be important supportive evidence of mitral valve prolapse when evaluating patients with atypical chest pain and palpitations. Antenatal factors may be involved in the pathogenesis of mitral valve prolapse since it is possible that a genetic or environmental factor that interferes with the development of the mitral valve may also influence epidermal ridge patterns.

Analysis of Variance↗
PubMed1976

Clinical features and investigative findings in presence of mitral leaflet prolapse. Study of 85 consecutive patients.

In a 14-month period mitral leaflet prolapse was diagnosed in 85 patients by echocardiography or cineangiography. Chest pain alone was the presenting complaint in 30 patients and linked with palpitation, dyspnoea, or syncope in 9. Eleven presented with major neurological disturbances (9 had transient ischaemic attacks), 10 with palpitation, 4 with undue and persistent fatigue, 2 with dyspnoea, and 2 with dizziness. Seventeen were referred not because of symptoms but because of clicks and murmurs. Overall, chest pain affected 61 patients and unless associated with coronary artery disease was not anginal. Palpitation was admitted by 42 patients; dizziness, lightheadedness, or paraesthesiae by 15, and syncope by 12. Systolic auscultatory abnormalities were noted in 69: 25 had single clicks, 3 had multiple clicks, 19 had both click(s) and murmur, and 22 had a murmur alone. Electrocardiography revealed ST segments flat for greater than 0-10 s in 21, prolonged QTc in 18, and T wave flattening or inversion in inferior limb and lateral chest leads in 14. The exercise stress test was abnormal in 13 of 27 patients. Mitral valve echograms showed definite mitral leaflet prolapse in 61, 'possible' prolapse in 14, and were normal in 8 patients with angiographic proof of mitral leaflet prolapse. Cardiac catheterization with left ventriculography showed prolapse of posterior mitral leaflet in 36, of both leaflets in 2, and left ventricular wall motion abnormalities in 16 cases. Selective coronary arteriography in 31 cases showed major vessel narrowing of larger than or equal to 80 per cent lumen diameter in 4, all with angina. This consecutive series indicates that the physical event of mitral leaflet prolapse is more common than hitherto appreciated, is priminently associated with non-anginal chest pain, palpitation, and neurological disturbances, and in 90 per cent of cases could be shown echocardiographically.

Adolescent↗
PubMed1977

Mitral valve prolapse in patients with coronary artery disease. Echocardiographic-angiographic correlation.

Echocardiography was performed in 25 consecutive patients with angina pectoris and angiographically demonstrable coronary artery disease. Left ventricular echograms detected late or pansystolic mitral valve bowing suggesting of mitral valve proplapse in 6/25 (24%). Left ventricular angiography showed prolapse of the posterior mitral leaflet in 15/25 (60%), including 5 detected by echocardiography. Significant triple vessel coronary disease was present in 11 of 15 patients with prolapsed mitralvalve. In each of the latter a greater than 90 per cent obstructive lesion was noted in at least one coronary artery: right coronary artery, 9 subjects (82%); left circumflex coronary artery, 5 patients (33%); and left anterior descending coronary artery, 4 patients (27%). Of 15 subjects with angiographic evidence of mitral valve prolapse, 13 had left ventricular asynergy-inferior or inferoposterior in 8 subjects (62%) and anterior or anteroapical in 5 subjects (38%). Eleven subjects had vectorcardiographic evidence of transmural myocardial infarction-inferior or inferoposterior in 9 (82%) and anteroseptal in 2 (18%). A single subject with mitral valve prolapse had mild mitral regurgitation. It is concluded that: (1) coexisting prolapse of the posterior mitral valve leaflet and coronary artery disease is usually associated with triple vessel obstructive lesions, (2) severe right coronary disease, inferior left ventricular wall asynergy, and inferior myocardial infarction are important angiographic and vectorcardiographic correlates, and (3) echocardiography will detect such mitral valve prolapse in only one-third of affected cases.

Adult↗
PubMed1975

Aortic root dilatation and mitral valve prolapse in Marfan's syndrome: an ECHOCARDIOgraphic study.

Echocardiographic and phonocardiographic findings in 35 patients with Marfan's Syndrome and ten patients without Marfan's or other clinically apparent connective tissue disorders but with angiographic and echocardiographic evidence of mitral prolapse are reported and compared. Echocardiography revealed aortic root dilatation and/or mitral valve prolapse in 97% of the patients with Marfan's Syndrome. Aortic root dilatation was found in 60% of this group (74% of males, 33% of females) while mitral valve prolapse was found in 91% (87% of males, 100% of females). The incidence of aortic dilatation and mitral prolapse in patients with Marfan's syndrome was essentially equal in children and adults of the same sex. None of the nine adults or one child with mitral prolapse but without evidence of Marfan's Syndrome or other clinically apparent connective tissue disorder had aortic root enlargement. Ausculatory examination and phnocardiography revealed abnormalities in 54% of the patients with Marfan's Syndrome. Aortic regurgitation was found in 23% of this group (35% of males, 0% of females) while mitral regurgitation and/or mitral clicks were found in 46% (39% of males, 58% of females). Aortic regurgitation was much more frequent in adult males with Marfan's Syndrome (7/14, 50%) than male children (1/9, 11%), while the incidence of abnormal mitral sounds was essentially the same in adults (33% of males, 60% of females) and children (43% of males, 57% of females) of the same sex with Marfan's Syndrome. Abnormal mitral sounds were more frequent in patients without Marfan's who had mitral prolapse (90%) than in those with Marfan's (46%). It appears that cardiac abnormalities are a consistent manifestation of Marfan's Syndrome and that ultrasound is a more sensitive indicator of these abnormalities in such patients than ausculation or phonocardiography.

Adolescent↗
PubMedDate not supplied

Treatment of scleral melt associated with uveal prolapse by pericardium grafting in Wegener's granulomatosis.

PURPOSE: To report the use of preserved pericardium tissue in the treatment of scleral melt associated with uveal prolapse secondary to Wegener's granulomatosis. Wegener's granulomatosis may initially present with ophthalmic findings including scleral melting with uveal prolapse. In order to preserve the globe and treat this potentially fatal disease, prompt diagnosis, surgical correction of uveal prolapse, and subsequent immunosuppressive therapy are imperative. If advanced scleral melt associated with uveal prolapse is present, pericardium grafting with conjunctival advancement is a useful technique. METHODS: Case report of a 70-year-old white female who initially presented with a unilateral sderal melt associated with uveal prolapse involving 6 clock hours of the surgical limbus. Emergent pericardium grafting of the involved limbus with conjunctival advancement performed to correct the endangered globe. Laboratory data including sedimentation rate, cANCA, computerized tomography of the chest, and urinalysis confirmed the diagnosis of Wegener's granutomatosis. RESULTS: After pericardium grafting and immunosuppressive therapy the patient returned to baseline visual acuity, the sedimentation rate normalized, and the pulmonary lesions and renal failure resolved. The patient has been followed for 3 years since the initial diagnosis of Wegener's granulomatosis and there has been no recurrence. CONCLUSIONS: To the best of the author's knowledge, this is the first report using processed pericardium to emergently treat scleral melt associated with uveal prolapse, thereby allowing preservation of the globe. In addition to management of the scleral melt, systemic evaluation and treatment with immunosuppressive therapy are necessary.

Aged↗
PubMed1976

[Variable aspects in mitral valve prolapse. Echographic and phonocardiographic studies of 68 cases (author's transl)].

Previous parallel echocardiographic-angiocardiographic studies have proven specificity and sensitivity of ultrasonography in diagnosing prolapse of the mitral valve. Echocardiograms and phonocardiograms from 68 patients with mitral valve prolapse were studied. Echocardiograms suggestive of mitral valve prolapse were obtained in 66 patients. The typical abnormality consisted of an abrupt posterior displacement of the mitral valve leaflets, either late systolic or pansystolic. Moreover a new pattern not previously described was observed, i.e. an abrupt isolated early systolic posterior motion of the mitral leaflets ("early prolapse"). Phonocardiography, on the other hand, showed a variable spectrum of acoustic findings: non-ejection systolic click and/or late systolic murmur, pansytolic murmur, early systolic click,ejectioarly systolic click, ejection murmur, in variable association, and finally no abnormal sound at all ("silent prolapse"). The authors conclude that mitral valve prolapse may be suspected, whatever the auscultatory finding. Echocardiography provides a useful, non invasive method for detecting those forms which also present an uncommon auscultatory pattern.

Adolescent↗
PubMedDate not supplied

Tricuspid valve prolapse: a common occurrence in the click-murmur syndrome.

Isolated mitral valve prolapse (MVP) may represent one end of a spectrum of disease involving dysfunction of multiple cardiac valves. Eighty-nine consecutive patients with MVP diagnosed by two-dimensional echocardiography (2-D echo) were prospectively studied specifically to determine the incidence of tricuspid valve prolapse (TVP) and its clinical correlations. Criteria for prolapse of the atrioventricular (A-V) valves by 2-D echo included extension of the valve leaflets behind an imaginary line defining the valve annulus. Forty-one of 82 patients with MVP had associated TVP. No significant differences existed between patients with isolated MVP and combined A-V valve prolapse with regard to sex, clinical history, symptoms, or physical examination. The parasternal long axis view was more sensitive than the apical four chamber view in diagnosing prolapse of either mitral or tricuspid valves. Thus, TVP is a frequent concomitant of MVP and occurs with equal frequency in both young and old patients.

Adolescent↗
PubMed1980

Tricuspid regurgitation in tricuspid valve prolapse demonstrated with contrast cross-sectional echocardiography.

To determine the prevalence of tricuspid regurgitation in patients with tricuspid valve prolapse and to define further the criteria for the diagnosis of tricuspid regurgitation on contrast echocardiography, evaluation was made of 45 patients who had adequate contrast studies. There were four groups of patients: Group A, 10 healthy control subjects with no evidence of structural heart disease on cardiac catheterization; group B, 10 patients with classic clinical evidence of tricuspid regurgitation; group C, 10 patients with cross-sectional echocardiographic evidence of mitral valve prolapse without tricuspid valve prolapse; and group D, 15 patients with both mitral and tricuspid valve prolapse on cross-sectional echocardiography. Tricuspid regurgitation was sought in each group by using the subxiphoid echocardiographic approach with peripheral venous injection of saline solution. The diagnosis required the presence of microcavitations in both the inferior vena cava and hepatic veins for at least three consecutive cardiac cycles. Tricuspid regurgitation was observed in no patients in group A, 10 of 10 patients in group B, 0 of 10 in groups C and 6 of 15 (40 percent) in group D. Contrast cross-sectional echocardiography proved to be a reliable technique for identifying tricuspid regurgitation with a high degree of specificity and sensitivity. Patients with tricuspid valve prolapse had a 40 percent prevalence rate of tricuspid regurgitation. This finding may identify a subgroup that requires particularly careful clinical follow-up care.

Adolescent↗