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PubMed1989

Mitral valve prolapse and anxiety disorders in patients with anorexia nervosa.

Much has been written about the occurrence of mitral valve prolapse among eating disordered patients. Despite this literature, a causal relationship between the two conditions has yet to be established. The present study evaluated 500 patients with eating disorders and demonstrated an association between a low median ideal body weight and the frequency of mitral valve prolapse (P less than 0.001). The physical signs and symptoms of mitral valve prolapse disappeared in eating disordered patients with the return of normal weight (P less than 0.001). Contrary to prior reports, there was no association between mitral valve prolapse and the occurrence of diagnosable panic or anxiety disorders. The results of this study suggest that the symptoms of anxiety and panic associated with mitral valve prolapse in eating disordered individuals may be due to physiologic change in cardiac status related to weight rather than central nervous system changes associated with classic anxiety disorders.

Adolescent↗
PubMed1989

Severity of mitral regurgitation in mitral valve prolapse syndrome. A Doppler echocardiographic study.

Thirty-three consecutive patients with mitral valve prolapse with a systolic murmur were evaluated using pulsed doppler echocardiography to quantify the severity of mitral regurgitation. There were thirteen (39%) patients with mild regurgitation, twelve patients (36%) with moderate regurgitation and eight patients (24%) with severe regurgitation. It was noticed that, all the patients with severe regurgitation had posterior leaflet prolapse. In contrast, patients with anterior leaflet prolapse had either mild or moderate regurgitation only. Our results suggest that the degree of mitral regurgitation differs depending on the leaflet that shows the prolapse, which may be of importance in the followup of patients with mitral valve prolapse.

Adult↗
PubMed1989

[Ventricular function in mitral valve prolapse: effects of beta adrenergic blockers with and without intrinsic sympathomimetic activity].

A corollary of the "cardiomyopathy therapy" implies that mitral valve prolapse may cause intrinsic myocardial depression. The impairment of ventricular function may not be detected in basal conditions, but could be unmasked by superimposing depressant factors. The use of beta-blockers constitutes the first choice treatment for the symptomatic management of patients with mitral valve prolapse. Therefore, we tested the hypothesis that myocardial depression could be shown during beta-blockade in the uncomplicated primary form of mitral valve prolapse. The results of echocardiographic and radionuclide angiographic evaluation of left ventricular function during basal conditions, as well as under beta-blockade with propranolol and pindolol, do not lend support to the cardiomyopathy hypothesis of the pathogenesis of primary mitral valve prolapse. However, significant decreases of heart rate, left ventricular ejection fraction and peak velocity of left ventricular systolic emptying were seen with propranolol, but not with pindolol. Beta-blockade with intrinsic sympathomimetic activity may be preferable therapeutic option for patients with mitral valve prolapse.

Adolescent↗
PubMed1989

Association of mitral valve prolapse and systemic abnormalities of connective tissue. A phenotypic continuum.

More than half of all patients evaluated in our clinic for the possible diagnosis of a heritable disorder of connective tissue could not be classified in the current nosology, yet they had considerable clinical evidence of a systemic defect of the extracellular matrix. As a group, these patients share many manifestations of the Marfan syndrome including long limbs, deformity of the thoracic cage, striae atrophicae, mitral valve prolapse, and mild dilatation of the aortic root. Clinical clustering did not emerge when patients were stratified by mitral valve prolapse or aortic dilatation. The clinical phenotype of patients with mitral valve prolapse constitutes a continuum, from Marfan syndrome at one extreme to isolated mitral valve prolapse due to myxomatous proliferation of the valve leaflets. In the absence of biochemical or DNA markers, discerning whether a patient with mitral valve prolapse and mild aortic root dilatation (in the absence of ectopia lentis or a family history) has Marfan syndrome, or another heritable disorder of connective tissue, will continue to be a clinical challenge. Until subclassification based on refined clinical, genetic, and laboratory investigations is possible, the patients we describe are best seen as having an "overlap" heritable connective-tissue disorder. We suggest the acronym "MASS phenotype" to emphasize involvement of the mitral valve, aorta, skeleton, and skin.

Adolescent↗
PubMed1989

Primary carcinoma of vagina with uterine prolapse.

Eleven cases of primary carcinoma of vagina were admitted in Kasturba Medical College Hospital during the last 10 years, of which 6 cases aged 44-72 years, were associated with 3rd degree uterine prolapse. All the patients attended the hospital in late stage in spite of having 3rd degree uterine prolapse. Blood stained discharge and ulceration on the prolapsed part, irreducible prolapse with urinary retention and marked oedema of local and surrounding tissues were the presenting symptoms. Lesion on the vagina varied in size from 5 cm to 15 cm. IVP in both the cases of irreducible prolapse and retention of urine revealed hydroureter and hydronephrosis bilaterally. X-ray chest revealed secondaries in one patient only. Histopathology of vaginal biopsy revealed well differentiated squamous cell carcinoma in 5 cases and undifferentiated squamous cell carcinoma in one. Since the patients were in late stage of malignancy and were inoperable, treatment with external telecobalt therapy was undertaken. One patient developed vesicovaginal fistula during the treatment period and another patient developed it at the end of telecobalt therapy.

Adult↗
PubMedDate not supplied

[Electro-echocardiographic correlation in mitral valve prolapse].

The study was performed in 33 patients with echocardiographic diagnosis of mitral valve prolapse (PVM), without any other associated heart disease. A 19 derivations electrocardiogram (ECG) was performed a direct inscription 4 channel Samborns 150 machine at 25 and 50 mm/sec. The purpose of the study was determine the alterations in ventricular depolarization and repolarization, and to correlate them with valve prolapse, as well as with cavitary and parietal dimensions, as measured by M mode and/or two-dimensional echocardiography. Left ventricular hypertrophy detected by ECG agreed with the ECO test in 77%; the sensitivity was of 86% and specificity of 67.5%. Left ventricular hypertrophy detected by ECG was not related with the type of prolapse. Ventricular repolarization alteration was very frequent (84.8%). Association of this parameter with initial notch of R in a VF becomes important for diagnosis suspicion (p less than 0.01). When the abnormal repolarization affected the anterolateral wall, posterior valve prolapse was frequent; when the posteroinferior region was the affected one, the prolapse occurred more frequently in both valves. An important correlation (p less than 0.01) was found between left ventricular dilatation detected by ECO and the abnormal ventricular repolarization.

Adolescent↗
PubMed1988

The pathology of mitral valve prolapse.

The gross criteria for diagnosing prolapsing mitral valve are: 1. interchordal hooding of the involved leaflets, 2. hooding or doming of leaflets towards the left atrium, 3. elongation of the involved leaflets resulting in an increase in valve area, 4. dilatation of the valve annulus in patients with severe mitral regurgitation. The posterior leaflet is most frequently affected. The involved leaflets, in general, are thickened, soft, greyish white and have a smooth atrial surface. Chordae tendineae are described as elongated, tortuous and attenuated or thinned. Deviations from normal chordal insertion have recently been observed which possibly appear to represent the underlying abnormality. Microscopic findings include significant thickening of the spongiosa and the fibrosa, changes in dense collagen fibers in the atrialis layer, occasionally, with fibrin platelet deposits. Histochemical characterization of changes in the spongiosa may also be helpful in the diagnosis. Ultrastructurally, there may be changes in collagen and elastic fibers as well as myxoid areas. On comparison of findings in surgically-removed mitral valves with those of control specimens from autopsy patients with no cardiac abnormalities, the length of the anterior and posterior leaflet as well as the annular ring diameter was larger in the valves with prolapse. Two-dimensional echocardiography accurately assessed leaflet length when compared to morphologic measurements, however, the annular diameter during systole or diastole was smaller. In patients with mitral regurgitation requiring surgery, mitral valve prolapse is the most common cause. Annular ring dilatation and chordae tendineae rupture appear to contribute substantially to incurrence of the mitral regurgitation. The heart weight is increased in the majority of patients with symptomatic mitral valve prolapse but normal, however, in those without symptoms. The most frequent complication of mitral valve prolapse is mitral regurgitation with or without congestive heart failure. Patients with redundant leaflets may be at high risk of sudden death. Young women with abnormal resting ECG, prolonged Q-T interval, family history of sudden death or complex ventricular arrhythmias may also be at a greater risk of sudden death. The incidence of infective endocarditis appears higher in those with redundant than in those with nonredundant valves. The incidence of cerebral ischemic events is low.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1988

Surgery for mitral prolapse.

Mitral valve prolapse is an increasingly common etiology among patients presenting for mitral valve surgery. From 1985 through 1987, a total of 457 patients underwent surgery for pure mitral regurgitation. Of these, 304 (67%) had underlying mitral prolapse, 57 (12%) had rheumatic valvulitis, 36 (8%) had underlying ischemic disease, and 22 (5%) had bacterial endocarditis. The anatomic disturbance in the patients with prolapse was chordal rupture in 189 (62%), chordal elongation in 69 (23%), and isolated annular dilatation in 46 (15%). Valvuloplasty techniques were used in 294 patients (64%) overall. Among those with mitral prolapse, 208 patients (68%) underwent reconstructive procedures. Operative mortality for the entire group was 7% and for the valvuloplasty group it was 4%. We conclude that 1. in our patient population mitral prolapse is the most frequent etiology among patients requiring surgery for mitral regurgitation; 2. valvuloplasty techniques are applicable in the majority of these patients; 3. valvuloplasty can be performed with low operative mortality. Over the long term, available results indicate good clinical status and low rates of reoperation and thromboembolic events for patients who have undergone mitral valvuloplasty.

Follow-Up Studies↗
PubMed1987

The mitral valve prolapse epidemic: fact or fiction.

In spite of two decades of research, the precise relationship of anatomic mitral valve prolapse (floppy valve) to the neuroendocrine disorder (MVP syndrome) remains unclear. In all likelihood they are two separate genetic disorders which travel together in some fashion. Mitral valve prolapse is a common disorder but progressive mitral regurgitation usually occurs late in life and in only a few patients. Other complications such as bacterial endocarditis, stroke, and sudden death are far less common but can occur at younger ages. The neuroendocrine syndrome in civilian life is mainly seen in young females (interestingly the peak incidence years correspond to peak female sex hormone output) but can be seen in males when subjected to unusual stress such as military service. More recent echocardiographic studies have questioned whether all prolapsing valves are truly abnormal. It has been shown that echographic prolapse can be produced in normal subjects by reducing venous return and impaired venous return may be present in some patients with the MVP syndrome. However, clicks and murmurs are apparently not heard when normal valves prolapse. It is our opinion that the presence of a click or typical murmur requires some anatomic abnormality of the mitral valve. One wonders if minimal valve abnormality (noted and dismissed by Davies) is the valve abnormality present in many young females with MVP syndrome, and that it may remain a mild abnormality throughout life. Recent psychiatric studies suggest that MVP is present in 30% of patients with Panic Disorder. It is not clear that this psychiatric syndrome is the same thing as the MVP syndrome. In Devereux's study, anxiety proneness was no different in the MVP cohort than in relatives without MVP. It is possible that diagnostic mixing of two similar but separate disorders has occurred, as has been the case since World War I. Perhaps the most important question is whether young patients with MVP syndrome and no echocardiographic criteria for "floppiness" will develop progressive mitral regurgitation or other complications in later life. In other words, how often is MVP syndrome in a young individual without echocardiographic evidence of a floppy valve a precourser to eventual progressive mitral regurgitation? Are there two different populations? Because of the long course of the disorder, several more years of observation (and, it is hoped, prospective longitudinal study) will be required to answer this question.

Female↗
PubMed1986

[Clinical problems in mitral valve prolapse: an echocardiographic review].

Several unsolved problems in the echocardiographic diagnosis of mitral valve prolapse were reviewed. At present, two-dimensional echocardiography is the most reliable method for assessing mitral valve prolapse. However, basic knowledge on the anatomical orientation of the mitral annulus, hitherto not sufficiently studied, is indispensable before making adequate echocardiographic diagnosis. The annulus is not like a geometrical plane and occupies certain millimeters' width between the left atrium and the ventricle. Therefore, assuming the left atrial margin of the annulus as the reference, many unmistakable prolapse with mitral regurgitation are overlooked, while assuming the left ventricular margins as the reference, some false positive diagnoses will be inevitable. Consulting several autopsy specimens, the author noticed that the central fibrous body, the site of the anterior mitral valve insertion to the interventricular septum, forms the most inferior part of the mitral annulus. This fact could explain a higher sensitivity of the apical four-chamber view for detecting anterior mitral valve prolapse reported by several investigators, and also more frequent over-diagnosis according to our experience. Although the author prefers the left ventricular margin of the mitral annulus defined by the long-axis view as the reference for echocardiographic diagnosis of mitral prolapse, further investigation should be made in relation to the clinical significance of this abnormality diagnosed by echocardiography.

Echocardiography↗
PubMed1988

The mechanism of urinary continence in women with severe uterovaginal prolapse: results of barrier studies.

Eleven continent women with severe degrees of uterovaginal prolapse underwent a complete urodynamic evaluation that included passive and dynamic urethral pressure profilometry with and without careful barrier reduction of their prolapse. The aim of barrier placement was to reduce, but not overcorrect, the prolapse and to restrict stress-induced mobility of the viscera posterior and superior to the urethra. Each of the women had very high pressure transmission ratios in each quarter of the urethra (means of 257, 187, 170, and 166% from internal to external quarters) that were significantly reduced with barrier placement (means of 78, 84, 85, and 101%). Eight of 11 subjects had pressure transmission ratios less than 90% in the proximal three-quarters of the urethra with the barrier in place, a finding in nearly all subjects with genuine stress urinary incontinence. Maximum urethral closure pressure on passive urethral pressure profilometry also decreased significantly from a mean of 75 to 45 cm H2O with the barrier in place. We conclude that the stress continence mechanism in women with severe prolapse results from posterior-superior visceral descent with stress, causing mechanical obstruction of the less mobile urethra. The evaluation methods described may be useful in predicting which of these patients may require concurrent urethropexy at the time of prolapse reduction surgery to prevent postoperative stress urinary incontinence.

Adult↗
PubMed1987

Rectal prolapse in young adults.

Electromyographic studies in young adults with rectal prolapse have shown that there are a group of persons who cannot pull their prolapses in who have got very abnormal electromyograms. If this group are treated with major pelvic floor surgery the electromyogram appears to return to almost normal in two years. There are other young adults with rectal prolapse who can pull the prolapse in by contracting their own pelvic floors whose electromyograms approximate more closely to the normal. This latter group were treated with the insertion of circumanal nylon. It seems possible to differentiate the two groups without using electromyography on the basis of whether or not they can pull in the prolapse by contracting the pelvic floor and therefore the selection between patients for major surgery and minor surgery can be a clinical one. Further it would seem that as an initial operation, even the patients who are in the bad group can be treated by good bowel training and in a lesser operation, that if the bowel is kept in, the electromyograph returns to normal and hopefully in some of the patients major surgery is avoided.

Adult↗
PubMed1986

[Clinical problems in mitral valve prolapse: an electrocardiographic review].

Electrocardiographic signs of mitral valve prolapse are essentially non-specific. Diagnosis must be based on the other methods, but whenever the diagnosis was established, the electrocardiographic abnormalities may have a certain significance to predict the natural course and prognosis. The reported results and those of our series of 111 cases were compared in detail. Resting and exercise electrocardiography of our series revealed no definite tendency of ST-T changes, arrhythmias and other abnormalities in cases with prolapse except a few signs. When the abnormalities were present, they were not related to the severity of prolapse, but premature ventricular contractions were more frequently observed in severe cases. Atrial fibrillation was observed in higher frequency in cases with mitral regurgitation. The other abnormalities were not conclusive to verify previous studies. When compared to 19 cases with neurocirculatory asthenia comfirmed by clinical tests including angiography, the similarity of electrocardiographic abnormalities was observed in many aspects, but arrhythmias were much more common in cases with mitral valve prolapse. On the other hand, exercise test was positive more frequently in cases with neurocirculatory asthenia. No conclusion was established as to the sites of prolapse and electrocardiographic abnormalities.

Adolescent↗
PubMed1986

[Venous and meningeal prolapse during enlarged trans-labyrinth approach].

One hundred consecutive operations using the enlarged trans-labyrinthic (ETL) approach for acoustic neurinoma performed by the same surgeon were analyzed to determine incidence of venous and/or meningeal prolapses. Findings showed that ETL approaches were normal in 51 cases : normal superficial sinusodural space--external auditory canal and on deep dissection a superior petrous sinus and jugular space separated from the internal auditory canal. Prolapse was observed in 49 approaches : 30 very narrow sinusodural spaces due usually to temporal meninges prolapse (76%) associated in 25% of cases with a prolapse of lateral sinus; 29 prolapses of jugular space and 10 of superior petrous sinus, detected mainly in the narrow sinusodural spaces. In these cases, superficial displacement of the temporal meninges and lateral sinus appears indispensable in order to recover normal operating conditions towards the labyrinth and pontocerebellar angle.

Ear, Inner↗
PubMed1986

Mitral valve prolapse: recent advances in diagnosis and therapy.

MVP is a common condition with rare life-threatening implications. Recent follow-up studies over several years in children, and young and middle-aged adults failed to suggest increase in prolapse in most of the subjects. Older individuals with MVP appear to have increased complications, primarily due to mitral regurgitation. Echocardiography supports the diagnosis of MVP made by auscultation in over 90% of individuals, with excellent reproducibility. MVP is more common in young women than young men. The prevalence of prolapse decreases with age in women; it is relatively constant in men. Although complications are rare, MVP is the most common underlying disorder in rupture of the chordae tendineae. These spontaneous ruptures are usually unassociated with infective endocarditis. Familial studies indicate that isolated MVP is an autosomal dominant condition with variable expression. It is recommended that first-degree relatives of patients with isolated prolapse be examined. Infective endocarditis is uncommon, but it is recommended that antibiotic prophylaxis be implemented in patients with prolapse and evidence for mitral regurgitation. Prolapse is frequently associated with autonomic imbalance, primarily an increased catecholamine sensitivity. The use of beta blockers may reverse symptoms secondary to this abnormality. Sudden death is exceedingly rare despite marked arrhythmias in many patients. On the basis of retrospective studies, sudden death is associated with floppy valves, marked mitral regurgitation, and arrhythmias. There is no evidence that any class of antiarrhythmic agents can prevent the rare sudden deaths in these patients.

Adult↗
PubMed1985

[Sudden death in mitral valve prolapse. Apropos of 2 cases].

Two cases of sudden death are reported in patients with mitral valve prolapse with mitral insufficiency. Both had significant impairment of left ventricular function. Irreversible ventricular fibrillation occurred in one patient one-half hour preceding a catheterization, whereas the other patient died during sleep. Review of the literature revealed 42 cases of sudden death in patients with prolapse. Occasionally left ventricular dysfunction or medication overdosage can explain or favor development of the terminal arrhythmia, but usually no precipitating factor other than prolapse can be identified. It appears impossible to identify actual subgroups at risk, although sudden death does occur more frequently in patients with a large amount of prolapse of both valves, previous syncopal episodes, and ECG abnormalities at rest. Complex ventricular arrhythmias are also reported, but their predictive importance is difficult to evaluate. Sudden death is a rare complication of mitral prolapse, fact which should conservatively influence indications for further supplementary testing and treatment in these patients.

Adult↗
PubMed1985

[Hyperthyroidism and mitral valve prolapse: comparative two-dimensional echocardiography study of a hyperthyroid and a control population totalling 104 patients].

Recent studies seem to demonstrate a higher incidence of mitral valve prolapse in hyperthyroid patients. A complete cardiological check-up including 2D echocardiography was performed in 52 hyperthyroid patients and 52 control subjects. In the hyperthyroid population, mitral valve prolapse was diagnosed 3 times, 5,8 p. 100 of cases. These 3 subjects were female; hyperthyroidism was nodular in 2 cases: Grave's disease was only present in 1 case. Hyperthyroidism was very active at the time of the echocardiographic study in those 3 patients. In the control group, mitral valve prolapse was observed in 4 cases (7.7 p. 100). These 4 patients were all female. The results of this study do not show a higher incidence of mitral valve prolapse in the hyperthyroid population than in the control group. Grave's disease was not more prevalent in hyperthyroid patients with mitral valve prolapse. On the other hand, there were significantly more female patients with MVP in both the hyperthyroid and control populations.

Echocardiography↗
PubMed1979

[Mitral valve prolapse syndrome in athletes].

The syndrome of mitral valve prolapse was diagnosed by means of echocardiography in 11 of 28 top-class athletes with functional systolic murmurs and in 4 of 16 athletes examined irrespective of the physical findings and complaints. The echocardiographic manifestations of the prolapse consisted in delayed systolic flexion of the posterior cusp (3 cases), early systolic prolapse of the posterior cusp (4) and holosystolic prolapse of both cusps (8). It is concluded that the syndrome of mitral valve prolapse occurs in athletes far more often than generally supposed and may be the cause of systolic murmurs, and the development of myocardial dystrophy due to chronic physical overstrain and disorders of cardiac rhythm.

Adolescent↗