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PubMed1979

Surgical correction of severe mitral prolapse without mitral insufficiency but with pronounced cardiac arrhythmias.

Despite what was considered adequate pharmacological treatment, the condition of six patients with severe mitral valve prolapse but with trivial or no mitral regurgitation deteriorated. These patients had marked weakness, chest pain, dyspnea, and arrhythmias. Because these patients found their condition to be intolerable, the prolapsed mitral valve was repaired. Electrocardiography, treadmill stress testing, and left ventirculography performed following operation showed complete repair of the valve and significant improvement over the preoperative findings in all six patients. Repair of the floppy mitral valve did not eradicate all abnormalities; however, it did significantly improve the chest pain, weakness, dyspnea, and arrhythmias in all six patients. Five patients no longer require any medication. The prolapsed mitral valve contributed significantly to the symptoms and arrhythmias, but it could not have been the sole cause for these patients' signs and symptoms. With complete correction of the prolapse in all six patients, few of the signs and symptoms of the disease persisted. Repair of severe mitral valve prolapse without mitral regurgitation is recommended only for those patients who continue to be severely symptomatic from chest pain, dyspnea, or ventricular arrhythmias after an extensive trial of adequate medical therapy.

Adult↗
PubMed1978

[Surgical management of vaginal prolapse following total uterus extirpation].

After discussing the frequency, aetiology, pathogenesis, possibilities for gynaecological surgery of true prolapse of the vaginal vault, which is limited of general vaginal prolapse following hysterectomy, were given information about own results of treatment in seven true cases (--0,65%) within eleven cases of prolapse of the vaginal vault under 1075 hysterectomies. The vaginal excision of peritoneal prolapse and plastic correction of the vaginal vault for preserving the functional capacity for intercourse were carried out with success in all the seven cases in one case bye the methode of SYMMONDS and PRATT. An anterior colporrhaphy snd a posterior colpoperineorrhaphy were carried out in other four cases. Hints were finally given for prophylaxis of prolapse of the vaginal vault.

Female↗
PubMed1982

[Criteria for the diagnosis of prolapsed mitral valve using phonocardiography and echocardiography].

Our criteria for the diagnosis of prolapsed mitral valve were proposed in this paper. With this abnormality, the principal alterations in the mitral valve consist of an abnormal systolic leaflet motion and mitral regurgitation with or without systolic clicks. Our criteria include: (1) auscultatory or phonocardiographic findings suggestive of mitral regurgitation or mitral complex abnormality, (2) a posterior displacement of the mitral valve throughout the latter half of systole by M-mode echocardiography, and (3) a systolic bulging or an apparent systolic ballooning of the mitral valve by two-dimensional echocardiography. A diagnosis of prolapsed mitral valve is justified in a given case if (1) plus one or two other findings are present. Several confusing M-mode and two-dimensional echocardiographic findings for the diagnosis of this condition are neglected in this criteria. We believe that the diagnosis of prolapsed mitral valve, as a rule, should depend on the presence of significant auscultatory or phonocardiographic finding which is a major manifestation of our criteria. However, our criteria seem to be inadequate for the diagnosis of a systolic ballooning of the mitral valve toward the left atrium which is frequently associated with atrial septal defect, since an apical systolic murmur is often absent. The mitral valve ballooning in atrial septal defect, however, is of functional origin, and should be differentiated from an organic prolapsed mitral valve. Thus, to be significant of prolapsed mitral valve, an apical auscultatory or phonocardiographic findings should be unequivocal.

Echocardiography↗
PubMed1981

Mitral-valve prolapse: prevalence in an Australian population.

The prevalence of mitral-valve prolapse in 200 volunteers (100 men and 100 women) was investigated by means of a combination of clinical, phonocardiographic, and echocardiographic findings. Mitral valve prolapse was documented on M-mode echocardiography in four men and four women, giving an over-all prevalence of 4%. In addition, symptoms and electrocardiographic abnormalities, which are reported to occur more commonly in patients with mitral valve prolapse, occurred with equal frequency in the subjects with mitral valve prolapse and in those without prolapse.

Adolescent↗
PubMed1981

Neurocirculatory asthenia and mitral valve prolapse--two unrelated entities?

Patients with neurocirculatory asthenia share common symptoms with patients having evidence of mitral valve prolapse. A link between these two conditions has been suggested but never documented. We have evaluated the prevalence of mitral valve prolapse among 42 young soldiers suffering from the neurocirculatory asthenia syndrome, using auscultation and echocardiography to detect the mitral abnormality. Four of the 42 subjects with neurocirculatory asthenia had both auscultatory and ultrasonic evidence of mitral valve prolapse. Since a similar prevalence of mitral valve prolapse has been reported among populations of presumably healthy young males or females, we conclude that mitral valve prolapse and neurocirculatory asthenia do not appear to be related.

Adult↗
PubMed1980

[Left ventricular hemodynamics at rest and during exercise in patients with idiopathic mitral valve prolapse syndrome (author's transl)].

Idiopathic Mitral Valve Prolapse has been regarded by some authors as a primary cardiomyopathy. To determine, if left ventricular hemodynamics at rest and during exercise are impaired, 20 young symptomatic patients with idiopathic mitral valve prolapse, proven by echo- and phonocardiography, without coronary artery disease or severe mitral regurgitation, underwent supine bicycle exercise stress testing. Pulmonary artery pressure, central venous oxygen saturation and cardiac index as well as heart rate were measured with a Swan-Ganz thermodilution catheter and the results compared with those of 10 voluntary normal subjects. Variance analysis showed no significant differences in global left ventricular hemodynamics between patients with idiopathic mitral valve prolapse and normal subjects at rest as well as during exercise. In addition no significant differences were found between patients with echocardiographical holosystolic or mesosystolic mitral valve prolapse. In patients with idiopathic mitral valve prolapse, global left ventricular hemodynamics are not impaired neither at rest nor during exercise.

Adolescent↗
PubMed1980

[Mitral valve prolapse syndrome].

Within one and a half year 24 patients with arrhythmias or chest pain were investigated to detect a mitral valve prolapse syndrome which was found in 9 cases by echocardiography. Within this group 6 patients complained of fatigue, dizziness, dyspnea or syncope, 6 had chest pain, 7 paroxysmal tachycardia and 2 patients premature beats. Auscultation revealed in 3 cases a systolic click, in 1 case a systolic click with late systolic murmur and in 5 cases a systolic murmur only. The ECG showed premature ventricular contractions in 2 patients, ST-T abnormalities in 6 patients. Echocardiography showed a late systolic prolapse in 6 and a pansystolic prolapse in 3 patients. In 3 cases also an angiography was performed and in this way a mitral valve prolapse detected; hemodynamics and coronary arteries were normal in all 3 cases but in one case a mitral insufficiency and in one case an asynergy of the anterior wall was found. Pathophysiology, clinical symptoms and phonocardiographic, echocardiographic and angiographic findings in mitral valve prolapse syndrome are discussed.

Adult↗
PubMed1994

The cumulative risks of prolapsing mitral valve. 40 years of follow-up.

Prolapsing mitral valve is a common cardiac condition, occurring in approximately 16 million people in the United States alone. Primary prolapsing mitral valve may be familial or nonfamilial and may be associated with myxomatous degeneration of the mitral valve leaflets, such as occurs in Marfan syndrome and other connective tissue disorders. Secondary forms may be associated with such entities as rheumatic fever (especially after commissurotomy) and coronary artery disease (in the presence of ruptured chordae tendineae), and with such congenital conditions as interatrial defect and primary cardiomyopathy with outflow tract obstruction. Prolapsing mitral valve is characterized by late systolic murmur, mid-systolic click, or both. Arrhythmias occur in the form of benign premature atrial contraction, premature nodal contraction, and paroxysmal atrial tachycardia. As the patient ages, atrial flutter and atrial fibrillation tend to develop. In some chronic cases, especially those involving atrial fibrillation, systemic emboli may occur. Rare premature ventricular contractions may be largely benign, whereas more frequent premature ventricular contractions may lead to severe arrhythmic complexes such as ventricular tachycardia or ventricular fibrillation. With advancing age, atrioventricular conduction defects of varying degrees or sick sinus syndrome may necessitate a pacemaker installation. About one quarter of prolapsing mitral valve cases progress, with increasing mitral insufficiency and increasing enlargement of the left atrium and left ventricle, which at times leads to congestive heart failure. Coronary artery disease may occur with the severity commensurate with the patient's age group. About three quarters of patients with prolapsing mitral valve syndrome lead normal lives.

Disease Progression↗
PubMedDate not supplied

[Evaluation of the sphincter function and rectal sensitivity in rectal prolapse associated with fecal incontinence].

It has been suggested that incontinent patients with rectal prolapse develop a relaxation of the internal sphincter at a lower filling volume than those with the same disorder who were continent. A constant relaxation of the internal sphincter during filling before the individual experiences a need to defecate could be a contributory cause of the incontinence in these patients. Aiming to evaluate the former observations we have investigated continent and incontinent patients, with complete and internal rectal prolapse, by mean of the recto-anal manovolumetry. 31 patients were studied, 21 had a complete rectal prolapse and 10 had internal rectal prolapse and 28 sex and age matched controls were selected among volunteers. No difference has been found between the continent and incontinent patients with rectal prolapse, in term of sensory function studied by graded isobaric distention. Moreover, no difference has been found between the rectal volume at which perception of filling and relaxation of the internal sphincter during filling occurs. Therefore, in this respect, the present data are not in agreement with the theory proposed.

Adult↗
PubMed1994

[A new surgical technique to reduce genital-urinary prolapse].

The authors describe a new surgical technique to reduce the prolapse of genitals and urinary organs. In retrospect, we studied 36 women--between the ages of 59 and 85--who had been hospitalized from 1988 through 1990 at the Ospedale di S. Anna of Rome and from 1991 through May 1994 at the Ospedale Sandro Pertini of Rome. Twenty-eight out of 36 patients presented a III prolapse of the uterus with cystorectocele; 4 patients had a prolapse of the cupola vaginae after hysterectomy; 4 patients presented a prolapse of the residual stump after sub-total hysterectomy. In addition, 8 out of 36 patients presented a stress incontinence. The technique described adopts a special nylon lace to fix prolapsed organs to the fascia musculorum rectorum abdominis. Its ease and brief execution time, together with the complete lack of relapse, have convinced the authors to promote the diffusion of this technique, which allows relief from these extremely distressing complaints often not fully cured with traditional techniques.

Aged↗
PubMed1993

[Reliability of biplane transesophageal color Doppler echocardiography in evaluating mitral valve prolapse: comparison with surgical findings].

The reliability of biplane transesophageal color Doppler echocardiography for the evaluation of mitral valve prolapse was assessed by comparison with surgical findings in 27 patients. The mitral valve prolapse site was classified as the medial, central, and lateral portions of the anterior leaflet, and medial, middle, and lateral scallops of the posterior leaflet. The prolapsed sites were determined by the site of systolic displacement using two-dimensional echocardiography, the site of flow acceleration and the direction of the mitral regurgitant jet using color Doppler echocardiography. The sensitivity of transesophageal echocardiography for detecting prolapse at the medial, central, and lateral portions of the anterior leaflet, and the medial, middle and lateral scallops of the posterior leaflet was 91, 100, 86, 83, 100, and 80%, respectively. The specificity was 100, 100, 96, 100, 89, and 100%, respectively. Biplane transesophageal echocardiography is a reliable method for detecting the site of mitral valve prolapse.

Adult↗
PubMed1994

[Relationship between rheumatic disease and mitral valve prolapse: an etiopathogenetic connection or the result of a semiologic confusion?].

The term mitral valve prolapse is used to describe either one of the pathophysiological mechanisms of mitral regurgitation or a distinct biological condition with a defined inherited basis, with or without mitral incompetence. In the former case, association with rheumatic fever is implied by the definition itself; in the latter it's questionable (rheumatic fever could act as an environmental factor in the expression of a genetically determined mitral valve prolapse). Three hundred and twenty patients with mitral valve prolapse, diagnosed as a primary one, were studied in order to assess the prevalence of a well-documented history of rheumatic fever: this resulted higher versus a control population (5.6% vs 0.9%-p < 0.01). The retrospective nature of the study does not allow a definite conclusion. Familial as well as long-term follow-up studies are necessary to better define the association between rheumatic fever and mitral valve prolapse; a potentially different prognosis, mainly accounting to the development of a clinically relevant mitral regurgitation in patients with mitral valve prolapse and previous rheumatic fever, has to be searched.

Adult↗
PubMed1993

Mitral valve prolapse: left ventricular hemodynamics in patients with chest pain, dyspnea or both.

Patients with mitral valve prolapse may present with chest pain and dyspnea. Left ventricular hemodynamics as a cause for these symptoms have not been completely evaluated in these patients. The present study was undertaken to investigate left ventricular hemodynamics in symptomatic patients with mitral valve prolapse. One hundred and three patients with mitral valve prolapse (female 72, male 31, age 56 +/- 11 years) had diagnostic cardiac catheterization for evaluation of chest pain (n = 44), dyspnea (n = 10) and for chest pain plus dyspnea (n = 49). All patients had diagnostic auscultatory findings and angiographic documentation of mitral valve prolapse. Patients with coronary artery disease and mitral regurgitation greater than mild were excluded from the study. Left ventricular end diastolic pressures before (chest pain 9.3 +/- 3.7 mmHg; dyspnea 8.2 +/- 4.2 mmHg; chest pain plus dyspnea 9.3 +/- 4.1 mmHg) and after left ventriculography (chest pain 11.6 +/- 5.5 mmHg; dyspnea 10.2 +/- 2.3 mmHg; chest pain plus dyspnea 11.7 +/- 5.6 mmHg) were normal in the majority of patients and similar in all three groups. Likewise, the left ventricular end diastolic volume index (chest pain 72.0 +/- 16 cm3, dyspnea 69.1 +/- 20 cm3, chest pain plus dyspnea 70.0 +/- 16 cm3) and ejection fraction (chest pain 64.0 +/- 8.4%, dyspnea 64.1 +/- 6.1%, chest pain plus dyspnea 64.3 +/- 6.1%) were normal in the majority of patients and similar in the three groups. Symptomatic patients with mitral valve prolapse without significant mitral regurgitation had normal left ventricular hemodynamics, and their symptoms cannot be explained on the basis of hemodynamic abnormalities alone.

Adult↗
PubMed1996

Simplified sutured sacral rectopexy for complete rectal prolapse in adults.

OBJECTIVE: To assess the results of simplified sutured sacral rectopexy for complete rectal prolapse. DESIGN: Prospective study. SETTING: University hospital, India. SUBJECT: 65 patients with complete rectal prolapse treated by modified sutured sacral rectopexy. MAIN OUTCOME MEASURES: Morbidity, mortality and recurrence. RESULTS: During a follow-up of 2-10 years (mean 5.4 years) none of the patients developed a recurrence of complete prolapse of the rectum but 3(5%) developed mucosal prolapse. The incontinence improved in 12 of 16 patients (75%) and constipation improved in 5 of 6 (83.3%). CONCLUSION: We conclude that the simplified sutured sacral rectopexy is a simple operation for treating complete rectal prolapse in adults, and gives good results.

Adolescent↗
PubMed1996

The Delorme procedure: a useful operation for complicated rectal prolapse in the elderly.

Full thickness rectal prolapse is a distressing and debilitating condition that often affects elderly patients. Fecal incontinence is usually present. Frequently, comorbid conditions or previous pelvic procedures complicate surgical care. A perineal approach may be used in these patients to avoid the complications of pelvic surgery and general anesthesia. The Delorme operation involves mucosal stripping and muscle plication of the rectal prolapse and is performed externally under regional or general anesthesia. We report our experience with this procedure in six elderly candidates who have undergone the Delorme procedure at the UCLA Center for Health Sciences in the past year. Two men and four women with a mean age of 78 +/- 12 years were followed over a mean of 11 +/- 4 months. Complicating factors included a mean of 1.7 failed prolapse operations per patient (0-6), pelvic radiation in two patients, and severe cardiac and pulmonary disease in two patients. Outpatient bowel preparations and same day admissions were used. Operative time averaged 80 minutes. No blood transfusions were required and postoperative stay averaged 2.7 days. A total of 67 per cent report improvement in continence. There was no major morbidity or mortality and only one recurrence. We conclude that the Delorme procedure is a safe and useful procedure for the treatment of complete rectal prolapse. Elderly patients, patients with failed prolapse operations, and those with prior pelvic surgery or radiation should be considered for this procedure.

Aged↗
PubMed1996

Functional results after abdominal suture rectopexy for rectal prolapse or intussusception.

OBJECTIVE: To assess the functional outcome after suture rectopexy in patients with rectal prolapse or intussusception. DESIGN: Retrospective study. SETTING: University hospital, Sweden. SUBJECTS: 33 patients with rectal prolapse and 19 patients with intussusception treated by abdominal suture rectopexy 1969-1992. MAIN OUTCOME MEASURES: Bowel function evaluated by a questionnaire a median of 97 months after operation. RESULTS: 10/33 patients (30%) reported less constipation after rectopexy in the prolapse group compared with 3/19 (16%) in the intussusception group (p = 0.33). Rectal emptying improved in 14/33 (42%) and 1/19 (5%), respectively (p = 0.005), and incontinence in 12/33 (36%) and 3/19 (16%), respectively (p = 0.20). Seventeen patients (52%) with prolapse and 3 (16%) with intussusception described the result of operation as excellent or good (p = 0.02). CONCLUSION: There is a reasonable chance of improved rectal emptying and continence in patients undergoing suture rectopexy for rectal prolapse, whereas bowel symptoms commonly worsen postoperatively in patients treated for intussusception.

Adult↗
PubMed1996

[Anesthesia for cesarean section in patients with mitral valve prolapse].

Mitral valve prolapse is the most frequent cardiac valvulopathy. Given its greater incidence in young women it is a factor which must be taken into account when performing cesarean section. Two patients with mitral valve prolapse in whom a cesarean section was carried out are presented: case 1, a 22-year-old woman, ASA II, 72 kg, with mitral valve prolapse associated with the Wolf-Parkinson-White syndrome and an episode of paroxysmal supraventricular tachycardia. The cesarean section which was indicated because of the absence of fetal progression was performed under epidural anesthesia. Forty-five minutes after regional blockade a hypotensive episode was observed which remitted following the i.v. administration of 6 mg of methoxamine. No other complication was reported. The Apgar score of the neonate at one minute was 7; case 2, a 31 year-old woman, ASA II, 51 kg, diagnosed with mitral valve prolapse with no associated symptomatology. A cesarean section was performed in this patient because of pedal presentation under general anesthesia without complications. The Apgar score of the neonate at one minute was 8. The physiopathology of mitral valve prolapse as well as anesthesia management during cesarean section in this type of valvulopathy is reviewed.

Adult↗
PubMed1996

[Cord prolapse. Review of the literature. A series of 50 cases].

OBJECTIVES: Identify the role of cord prolapse in modern obstetrics by estimating the frequency of this obstetrical accident, its conditions, prognosis and treatment and by analyzing factors favoring development of cord prolapse. METHOD: From a retrospective study of 50 observations of cord prolapse occurring in the department of obstetrics from January 1985 to June 1994. Results were compared with those reported in the literature. RESULTS: The frequency of cord prolapse was 0.21% over the 10-year period. Cesarean section was required in 72% of the cases, and obstetrical manoeuvers were used in some of the vaginal deliveries (28%). Neonatal mortality was 20/1000. Predisposing factors were breech presentation, prematurity, twin pregnancy and multiparity. CONCLUSION: Despite much progress in obstetrics, the frequency of cord prolapse has not changed over time. The consequences are not as lethal as in the past, because of progress in diagnosis and neonatal resuscitation. Fetal prognosis remains however severe.

Adult↗