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PubMed1981

Diastolic sounds and murmurs associated with mitral valve prolapse.

Although mitral valve prolapse is often associated with a systolic click or murmur, it is not widely appreciated that a sound or murmur may also occur in diastole. Nine patients with a systolic click or murmur and echocardiographic evidence of mitral prolapse had, in addition, a diastolic sound or an early diastolic murmur best heard at the apex or left sternal border. The sound, which was of high frequency and easily audible, followed A2 by 70-110 msec (mean 94 +/- 5 msec), and coincided with the point where the prolapsed posterior leaflet returned from the left atrium and recoapted with the anterior mitral leaflet. The diastolic sound occurred 40-60 msec (mean 53 +/- 4 msec) before the E point of the echocardiogram and O point of the apexcardiogram, and even longer before the rapid-filling wave. The diastolic murmur, also of high frequency, was brief and decrescendo, and simulated aortic regurgitation in two patients. Thus, mitral prolapse may be associated with a sound or murmur in diastole. When a diastolic sound or murmur is best heard apically, even if accompanied by a systolic murmur, mitral valve prolapse should be considered.

Adult↗
PubMed1987

Pressure-flow relations across the normal mitral valve.

The stenotic mitral valve area is a major determinant of the atrioventricular pressure-flow relation, and mean atrioventricular pressure gradient is proportionate to the square of mean flow rate. In the absence of obstruction, this relation is linear. The effect of the normal mitral valve area on this pressure-flow relation has not been previously examined. Pulsed Doppler studies of transmitral flow were performed simultaneously with thermodilution cardiac outputs in 25 patients in sinus rhythm and with no valvular disease. Mean flow rate was determined as thermodilution stroke volume/diastolic filling period measured by Doppler. Several instantaneous pressure gradients were estimated from multiple velocity measurements using the modified Bernoulli equation and were plotted against time. Mean pressure gradient was estimated by dividing the area under the pressure-time curve by the diastolic filling period. Average and standard deviation of mean flow rate and pressure gradient was 223 +/- 70 ml/s and 1.4 +/- 0.8 mm Hg, respectively. There was an excellent linear correlation between these 2 parameters (r = 0.91, SEE = 30 ml/s). This confirms the linear relation of mean pressure gradient to mean flow rate in the absence of obstruction. The excellent correlation, obtained without considerations of individual variations of valve area, suggests that this relation is independent of valve area, under normal physiologic conditions.

Blood Flow Velocity↗
PubMed2005

A very unusual combination of straddling and overriding of the tricuspid valve associated with clefting of the mitral valve.

We describe a patient in whom we found dual orifices in a straddling and overriding tricuspid valve, with two normally sized ventricles and a cleft in the mitral valve. The patient underwent successful surgical repair. We discuss the concept of "double-orifice right atrium", as well as the need to differentiate the isolated cleft of the morphologically mitral valve from the zone of apposition between the left ventricular components of the bridging leaflets seen in the setting of atrioventricular septal defect with common atrioventricular junction. We emphasise the unusual association of these abnormalities of the right and left atrioventricular valves in patients with separate atrioventricular junctions.

Adolescent↗
PubMed1990

[Ophthalmologic complications in mitral valve prolapse].

Usually, mitral valve prolapse is a benign condition, but there are some reports about ischemic cerebral or ocular insults. Among our patients with ischemic ophthalmic diseases we found seven with no risk factors other than mitral valve prolapse. The ages ranged from 18 to 61 years. Three patients suffered from monocular amaurosis fugax. Two patients showed a transient homonymous visual field defect. One patient had a vascular brain-stem lesion in the lower pons, causing a skew deviation. One patient showed typical anterior ischemic optic neuropathy. All but one patient (ischemic optic neuropathy) recovered completely. We recommend secondary prophylaxis with low-dose aspirin in cases where the symptoms persist longer than 24 h.

Adolescent↗
PubMed1992

Early experiences of intra-operative trans-oesophageal echocardiography (TEE) in mitral valve repair.

Whenever possible Mitral valve repair should be performed instead of Mitral valve replacement. It is important to assess the adequacy of the repair during the operation so that any corrective steps may be taken immediately. We present three cases of Mitral valve repair in which the intraoperative TEE was used to assess the adequacy of the repair. There was good correlation of the immediate post bypass TEE findings and early post operative transthoracic echocardiographic findings. Intraoperative TEE is a useful tool in the early assessment of Mitral Valve Repair.

Adult↗
PubMed1987

Mechanisms of severe mitral regurgitation in mitral valve prolapse determined from analysis of operatively excised valves.

Certain clinical and mitral valvular morphologic findings are described in 83 patients (age 26 to 79 years [mean, 60]; 26 women [31%] and 57 men [69%]) with mitral valve prolapse (MVP) and mitral regurgitation (MR) severe enough to warrant mitral valve replacement. All 83 operatively excised valves were examined by the same person, and all excised valves had been purely regurgitant (no element of stenosis). No patients had hemodynamic evidence of dysfunction of the aortic valve. In each valve a portion of the posterior mitral leaflet was elongated such that the distance from the distal margin to basal attachment of this leaflet was similar to the distance from the distal margin of the anterior leaflet to its basal attachment to the left atrial wall. Two major mechanisms for the severe MR were found: dilatation of the mitral anulus with or without rupture of chordae tendineae and rupture of chordae tendineae with or without dilatation of the mitral anulus. Of the 83 patients, 48 (58%) had both dilated anuli (greater than 11 cm in circumference) and ruptured chordae tendineae; 16 (19%) had dilated anuli without ruptured chordae, and 16 (19%) had ruptured chordae without significant anular dilatation. In three patients the anulus was not dilated, nor were chordae ruptured, and therefore the mechanism of the MR is uncertain. Mitral chordal rupture was nearly as frequent in the 64 patients with clearly dilated anular circumferences as in the 19 patients with normal or insignificantly dilated anular circumferences (less than or equal to 11 cm).

Adult↗
PubMed1995

[Repair of a left ventricular rupture after mitral valve replacement].

A 70-year-old patient (NYHA IV), who required a Carpentier pericardial prosthetic valve for mitral valve replacement, developed a type 2 intraoperative left ventricular rupture (mid portion of left ventricle) with cataclysmic bleeding. A successful repair with intraventricular dacron patch was performed by suturing the patch on the prosthetic sewing ring and through the ventricular wall using pledgetted stitches. The postoperative course was satisfactory without extensive myocardial necrosis and the patient is well 7 months later without angina and with reduced dyspnoea (NYHA II). Pre and postoperative left ventricular function were similar. These ventricular injuries after mitral surgery are well known but always difficult to manage and characterized by a high mortality rate. This technique (including prosthetic valve removal and intraventricular repair) seems to provide a greater chance of success than other external repair techniques. The best treatment remains prevention and consists in preserving the posterior mitral leaflet, avoiding extensive decalcification or resection and using low profiled prosthetic mitral valves. Likewise, mitral repair must be attempted as often as possible, because, in our opinion, this complication has never been reported in conservative mitral surgery.

Aged↗
PubMed1986

Long-term results of valve repair in children with acquired mitral valve incompetence.

From March 1969 to March 1984, 89 children aged 2 to 12 years (mean 8.3 +/- 2.5) with acquired mitral valve incompetence underwent mitral repair using Carpentier's techniques. There were 84 cases of rheumatic valve disease, four cases of endocarditis, and one case of Barlow's syndrome. Valve dysfunction was classified into three types: type I (normal leaflet motion), five patients; type II (prolapsed leaflet), 74 patients; and type III (restricted leaflet motion), 10 patients. Cumulative follow-up was 546 patient/years. At 10 years, 90% of the patients were still alive, with an incidence of valve-related death of 5.5%; 98% of the patients were free of thromboembolism, 78% were free of reoperation, and 69% of the patients were free of any complications related to valve repair. We conclude that whenever feasible (92% of the cases in our experience), mitral valve repair using valvuloplasty techniques is the preferred procedure in the surgical treatment of acquired mitral valve incompetence in children.

Child↗
PubMedDate not supplied

[Mitral valve prolapse].

INTRODUCTION: Mitral valve prolapse (MVP) is a common finding in everyday clinical practice. However, despite simple diagnostics, clinicians remain interested in it due to its undetermined prevalence, various etiology, clinical features and echocardiographic findings. ETIOLOGY AND PREVALENCE: MVP exists as a primary condition and is commonly associated with tissue diseases of familial origin. It is more common in people with asthenic constitution and congenital thoracic abnormalities. Secondary etiology occurs in rheumatic processes on mitral valve, hypertrophic cardiomyopathy and ischemic heart disease. The prevalence varies between 0.33-17%. DIAGNOSIS AND COMPLICATIONS: Clinical manifestations are different and in most patients asymptomatic. The diagnosis is established by anamnesis, physical examination, M-mode and 2-dimen-sional transthoracic and transesophageal echocardiography, left ventriculography and direct histopathologic investigation of mitral apparatus. Although MVP is a benign condition, there are certain complications such as infective endocarditis, severe mitral regurgitation, heart failure, cerebral and coronary embolism events, arrhythmias and sudden death. Complications mostly occur in patients with heart murmurs and mitral insufficiency in contrast to patients with cusps.

Humans↗
PubMed1996

Extensive use of artificial chordae for repairing diffuse mitral valve prolapse.

A diffuse mitral valve prolapse was successfully repaired in 2 patients using polytetrafluoroethylene sutures as artificial chordae. In a 16-year-old boy with Marfan's syndrome and in a 56-year-old woman, a total of 11 and ten pairs of polytetrafluoroethylene sutures were used, respectively, to repair a severe mitral valve prolapse. We consider mitral valve repair using polytetrafluoroethylene sutures to be the treatment of choice for a diffuse prolapse of the mitral valve involving both the anterior and posterior leaflets.

Adolescent↗
PubMed1992

Interpretation of cardiac pathophysiology from pressure waveform analysis: mitral valve gradients: Part I.

The mitral valve gradient is dependent on the precise measurement of left atrial (or pulmonary capillary wedge) and left ventricular pressures. Artifacts involving either pressure measurement will produce inaccuracies which may have clinical significance. Several methods and formulas using both invasive and noninvasive techniques should verify clinical findings and confirm the severity of mitral valve disease prior to definite therapy. The changes in mitral valve gradients after balloon catheter valvuloplasty will be discussed in part II of this hemodynamic rounds.

Blood Flow Velocity↗
PubMed1980

Mitral valve prolapse: whiplike motion of the posterior mitral leaflet detected by two-dimensional echocardiography.

Thirty-four patients with symptoms suggesting mitral valve prolapse were evaluated by M-mode echocardiography, real time, two-dimensional, phase array echocardiography, and cardiac catheterization. Ten of these patients had unequivocal evidence of mitral valve prolapse during cardiac catheterization. This diagnosis was established initially by M-mode and two-dimensional echocardiographic techniques. A characteristic "whiplike" motion of the posterior mitral leaflet was seen in 7 patients. The posterior mitral leaflet was moving successively toward the left atrium and left ventricle during the cardiac cycle. Arching of one or both mitral leaflets was also seen in patients with mitral valve prolapse during two-dimensional echocardiography. Two-dimensional echocardiography significantly enhances the mitral valve prolapse evaluation, but further experience and better techniques are necessary to explain many of the signs associated with this abnormality.

Adult↗
PubMed1993

[Surgical treatment for mitral valve defects with preponderance of mitral stenosis and high pulmonary vascular resistance. Clinical and hemodynamic observations 6 months after valve replacement].

10 patients with isolated or predominant mitral stenosis (mean mitral valve area 0.9 cm) and high preoperative values of pulmonary vascular resistance (mean 7.2 Wood units) were chosen for further hemodynamic postoperation evaluation. The patients had normal function of the aortic valve and no significant stenosis of coronary arteries. Hemodynamic evaluation was done by floating Swan-Ganz catheter preoperatively at rest and 6 months after mitral valve replacement at rest and during bicycle cycloergometer test in the supine position. Significant improvement in NYHA class was noted. Preoperatively 6 patients were in NYHA III class, 4 in NYHA IV class. After mitral valve replacement 4 patients were in class III and 6 in class II. Before mitral valve replacement only 3 patients were able to perform 25 Watt test. After surgery all except one performed at least 25 W. There was a significant decrease of pulmonary vascular resistance from 7.2 +/- 2.2 preoperatively to 3.1 +/- 1.9 Wood units at rest after the operation. Post operation during exercise pulmonary vascular resistance attained 4.2 +/- 1.9 Wood units. These changes were due to a fall in mean pulmonary artery pressure 49 +/- 13 at rest preoperatively to 25 +/- 6 mm Hg (rest) and 43 +/- 14 mm Hg (23 W) postoperatively and a rise in stroke volume index from 24 +/- 7 ml (m2) beat preoperatively to 32 +/- 9 at rest and 33 +/- 6 (25 W) postoperatively. Despite clinical and hemodynamic improvement there was no full recovery of pulmonary hemodynamics.

Adult↗
PubMed1986

[Tricuspid valve insufficiency in patients with rheumatic mitral valve disease: angiographic diameter of the tricuspid ring and function of the right ventricle].

Dilatation of the right ventricle and a consecutive enlargement of the tricuspid valve ring are thought to be the main causes of functional tricuspid regurgitation in patients with rheumatic mitral valve disease. To study the effect of right ventricular dilatation as well as the dimension of the tricuspid valve ring, right ventricular volume indices, ejection fraction, regional shortening, pulmonary artery pressure, and the diameter and systolic shortening of the tricuspid valve were determined in 67 patients with rheumatic mitral valve disease (NYHA class II and III) from biplane ventriculographies. Patients with right ventricular enlargement (greater than 90 ml/m2) were divided into groups with (group IIA) and without (group IIB) tricuspid regurgitation and compared with patients with normal right ventricular size and function without tricuspid regurgitation (group I). There was no difference in the end-diastolic volume index, in the afterload or in the diameter of the tricuspid ring. Right ventricular ejection fraction was decreased in group IIA (51 +/- 9% vs. 59 +/- 10% (IIB) and 61 +/- 6% (control); (p less than 0.05). Regional function was also decreased in group IIA. 73% of the patients with tricuspid regurgitation had right ventricular enlargement, but only 44% of the patients with right ventricular enlargement had tricuspid regurgitation. Thus right ventricular dilatation promotes the development of a tricuspid insufficiency, but is not the only cause. Additional factors like decreased local wall motion, alterations of the valve or the valve apparatus may also account for functional tricuspid regurgitation.

Angiography↗
PubMed2003

Increased distance between mitral valve coaptation point and mitral annular plane: significance and correlations in patients with heart failure.

OBJECTIVE: To measure the distance between the mitral leaflet coaptation point and the mitral annulus (CPMA) and assess the relation of this index to structural and functional characteristics of the failing left ventricle. DESIGN: Echocardiographic indices and CPMA were measured at baseline and again during dobutamine infusion and leg lifting. Left ventricular diastolic and systolic dimensions, left ventricular ejection fraction (LVEF) by Simpson's rule, mitral annulus dimension, and E point septal separation were correlated with CPMA. SETTING: Tertiary referral centre. PATIENTS: The total study population of 129 patients included 94 with LVEF < 35% and 35 with LVEF 35%-45%; 76 had coronary artery disease and 53 had dilated cardiomyopathy. INTERVENTIONS: A dobutamine infusion was given in 18 patients and preload increase by leg lifting in 28. MAIN OUTCOME MEASURES: Correlations between CPMA and contractility indices at baseline and during interventions. RESULTS: CPMA was correlated with left ventricular diastolic dimension (r = 0.52), left ventricular systolic dimension (r = 0.53), LVEF (r = -0.44), fractional shortening (r = -0.42), E point septal separation (r = 0.48), and mitral annulus dimension (r = 0.44) (all p < 0.001). Dobutamine decreased CPMA from (mean (SD)) 12.04 (3.64) mm to 8.92 (2.56) mm and increased LVEF from 27 (6.2)% at baseline to 33.4 (6.9)% at 10 microg/kg/min (both p < 0.001). These changes were strongly related (r = 0.68, p < 0.007). After leg lifting, CPMA decreased from 13 (4) mm at baseline to 10 (3) mm (p < 0.001), and LVEF increased from 32 (11)% at baseline to 39 (11)% (p < 0.001). Fractional shortening and left ventricular diastolic dimension also increased (p < 0.001) and mitral annulus dimension and E point septal separation decreased (p < 0.002), but left ventricular systolic dimension did not change. CONCLUSIONS: The mechanism displacing the mitral coaptation point towards the left ventricular apex is multifactorial. The correlations between CPMA difference (before versus after interventions) and ejection fraction difference (before versus after interventions) shows that this index depends mainly on left ventricular function.

Adult↗