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PubMed1983

Mitral valve prolapse and agoraphobia.

Of 46 female agoraphobic patients, three had definite and four had probable mitral valve prolapse--a total prevalence of only 15%. There were no significant differences between patients with mitral valve prolapse and the rest of the sample on demographic and clinical variables, nor did the groups differ significantly on measures of psychological symptoms assessed before and after treatment. These negative findings support recent reports indicating that agoraphobia associated with mitral valve prolapse may be indistinguishable from agoraphobia without mitral valve prolapse.

Adolescent↗
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↗
PubMed1984

Mitral valve prolapse.

Mitral valve prolapse is a very common condition. It occurs in 4-5% of the population. It may be idiopathic or associated with a number of other conditions. Myxomatous degeneration is the underlying mechanism of mitral valve prolapse. Most patients with mitral valve prolapse have no symptoms. When symptoms do occur, palpitations, chest pain and dyspnea are the major complaints. The midsystolic click occasionally followed by the late systolic murmur are the typical physical findings. The echocardiogram plays a big role in the diagnosis of mitral valve prolapse. The beta blockers are used in the treatment of the symptomatic patient.

Adrenergic beta-Antagonists↗
PubMed2001

Arytenoid prolapse as a consequence of cricotracheal resection in children.

Cricotracheal resection (CTR) is a technique introduced comparatively recently for treating severe laryngotracheal stenosis in children. The recognized complications of CTR include recurrent laryngeal nerve damage, anastomotic dehiscence, and restenosis. We describe a further complication of CTR, namely, prolapse of the arytenoid cartilage. The presentation may be late, with symptoms of shortness of breath on exertion and nocturnal stertor with a poor sleep pattern, or the prolapse may be an asymptomatic incidental finding. The diagnosis is performed with flexible nasopharyngoscopy with the patient unanesthetized, or with rigid endoscopy with the patient lightly anesthetized and spontaneously ventilating. The affected arytenoid cartilage is noted to prolapse anteriorly and medially with inspiration, partly obstructing the airway. If treatment is required, endoscopic laser partial arytenoidectomy is effective. In a series of 44 children who underwent CTR, 20 were noted to develop arytenoid prolapse after operation. Twelve were asymptomatic, and 8 required laser arytenoidectomy, 2 of whom now require continuous positive airway pressure for moderate supraglottic collapse.

Adolescent↗
PubMed1995

Mitral valve prolapse and the risk of stroke after initial cerebral ischemia.

Referral-based studies suggest that patients with cerebral ischemia and mitral valve prolapse are prone to recurrent cerebral ischemic events. Our purpose was to determine the risk of subsequent stroke in a population-based group of patients with ischemic stroke or TIA and mitral valve prolapse. From 1975 through 1990, 49 residents of Olmsted County, MN, had an initial ischemic stroke or TIA and echocardiographically diagnosed mitral valve prolapse. Risk of subsequent stroke in this cohort was compared with the age- and sex-adjusted rates of recurrent stroke after initial cerebral ischemia in the Rochester, MN, population. Mean age of the patients was 72 years. Thirty-one (63%) were women. Nine had subsequent stroke (5.5 per 100 person-years). For Rochester patients who had initial ischemic stroke in the period 1975 through 1984, 10.72 recurrent strokes were expected (relative risk, 0.84; 95% confidence limits, 0.38 to 1.59). For Rochester patients with initial ischemic stroke or TIA in the period 1975 through 1979, 12.31 recurrent strokes were expected (relative risk, 0.73; 95% confidence limits, 0.33 to 1.39). There is no evidence of increased subsequent stroke risk among patients with initial episodes of cerebral ischemia and mitral valve prolapse relative to the age- and sex-adjusted recurrent stroke rates in the community.

Aged↗
PubMed1981

Observer variation in the angiocardiographic diagnosis of mitral valve prolapse.

The purpose of this study was to assess the reliability of the angiocardiographic diagnosis of mitral valve prolapse by measuring agreement between observers using defined diagnostic criteria. Sixty high-quality left ventriculograms, selected to include many that showed possible mitral valve prolapse, were reviewed by three angiocardiographers. Disagreement between observers as to positivity occurred in 26 percent and 30 percent of the cases on two reviews, and disagreement as to specific scallop involvement occurred in 68 percent and 78 percent of the cases. A specific observer agreed with himself in interpretation of positive 78 to 82 percent of the time and in the interpretation of specific scallop involvement 55 to 90 percent of the time. These results indicate that in the absence of generally agreed upon quantitative angiocardiographic criteria for the diagnosis of mitral valve prolapse, there is considerable variability among observers in the interpretation of mitral valve prolapse by angiocardiographic studies.

Angiocardiography↗
PubMed1981

The effect of congesting cuffs on the echo-phonocardiographic findings in mitral valve prolapse.

Changes in left ventricular volume appear to be important in changing the timing and duration of mitral valve prolapse. In this study, simultaneous phonocardiograms and echocardiograms were recorded in 16 patients with late systolic mitral valve prolapse before and after the inflation of congesting cuffs (tourniquets) on the upper and lower extremities. The tourniquet application, known to reduce the venous return, caused a statistically significant movement of the phonocardiographic recorded click toward the first heart sound, associated with reduction of the echocardiographic left and right ventricular and left atrial dimensions. These findings confirm the relationship between the mitral valve prolapse and left ventricular dimension and suggest that a decrease in left ventricular volume is a tenable explanation for the earlier onset of prolapse.

Cardiac Volume↗
PubMed1982

Disappearance of echocardiographic mitral valve prolapse during ventricular pacing with retrograde artial activation.

M-mode echocardiography in a 68-year-old man with a permanent transvenous pacemaker revealed intermittent mitral valve prolapse. The mitral valve prolapse was present during normal sinus rhythm as well as during pacemaker beats either preceded by or not associated with any P wave activity. During pacemaker beats followed by retrograde P waves, the mitral valve prolapse was no longer seen. It is postulated that atrial contraction during ventricular systole produced a rise in left atrial pressure and prevented the mitral valve leaflets from prolapsing into the left atrium.

Aged↗
PubMed1986

Spontaneous pneumothorax and mitral valve prolapse.

We searched for mitral valve prolapse in patients with spontaneous pneumothorax to test the hypothesis that both may be part of a common disorder of connective tissue. Echocardiographic mitral valve prolapse was found in 11 (50 percent) of 22 patients who had suffered spontaneous pneumothorax compared to four (10 percent) of 40 age-matched control subjects (p less than 0.01). The body mass index (BMI) (weight/height2) was lower (p less than 0.001) in the group with pneumothorax; in five patients who were the thinnest in the study (BMI less than 2 standard deviations lower than mean normal value), mitral valve prolapse was present in four. The finding of a strong association of spontaneous pneumothorax with mitral valve prolapse, especially in subjects with an abnormal body build, suggests that in many patients, spontaneous pneumothorax may be a manifestation of a systemic abnormality of connective tissue.

Adult↗
PubMed2004

Surgical treatment of rectal prolapse: experience and late results with 51 patients.

UNLABELLED: The "best" surgical technique for the management of complete rectal prolapse remains unknown. Due to its low incidence, it is very difficult to achieve a representative number of cases, and there are no large prospective randomized trials to attest to the superiority of one operation over another. PURPOSE: Analyze the results of surgical treatment of complete rectal prolapse during 1980 and 2002. METHOD: Retrospective study. RESULTS: Fifty-one patients underwent surgical treatment during this period. The mean age was 56.7 years, with 39 females. Besides the prolapse itself, 33 patients complained of mucous discharge, 31 of fecal incontinence, 14 of constipation, 17 of rectal bleeding, and 3 of urinary incontinence. Abdominal operations were performed in 36 (71%) cases. Presacral rectopexy was the most common abdominal procedure (29 cases) followed by presacral rectopexy associated with sigmoidectomy (5 cases). The most common perineal procedure was perineal rectosigmoidectomy associated with levatorplasty (12 cases). Intraoperative bleeding from the presacral space developed in 2 cases, and a rectovaginal fistula occurred in another patient after a perineal rectosigmoidectomy. There were 2 recurrences after a mean follow-up of 49 months, which were treated by reoperation. CONCLUSION: Abdominal and perineal procedures can be used to manage complete rectal prolapse with safety and good long-term results. Age, associated medical conditions, and symptoms of fecal incontinence or constipation are the main features that one should bear in mind in order to choose the best surgical approach.

Adult↗
PubMed1998

Transsacral rectopexy for complete rectal prolapse.

A prospective study was carried out to analyze the clinical and functional results of transsacral rectopexy with a DEXON mesh in the elderly or poor risk patients with complete rectal prolapse. Six patients with complete rectal prolapse were operated from 1994 to 1996. All patients could be traced for examination with anorectal manometry and defecography. None of the patients had recurrence for the longest three years. In postoperative clinical symptoms, fecal incontinence score recovered from the preoperative mean score of 3.8 to the postoperative 1.2 and constipation was improved in 4 out of 5 cases (80.0%). Straining anorectal angle (S-ARA) by defecography improved from the preoperative value of 120.6 +/- 6.9 degrees to the postoperative value of 98.5 +/- 3.5 degrees (p < 0.05) and the perineal descent (PD) improved from the preoperative value of 16.2 +/- 2.5 cm to the postoperative value 8.1 +/- 1.3 cm (p < 0.05). Maximal resting pressure (MRP) increased from the preoperative value of 20.5 +/- 3.7 cmH2O to the postoperative value of 40.5 +/- 4.8 cmH2O (p < 0.05). Transsacral rectopexy with DEXON mesh for complete rectal prolapse is useful as this technique is simple to conduct, can be applied to the elderly or poor risk patients, replaces rectal prolapse, improves defecation troubles and recovers fecal incontinence.

Aged↗
PubMed1992

Transvaginal sacrospinous colpopexy for vaginal vault and complete genital prolapse in aged women.

Twenty-five women (mean age 72.8 years) with massive eversion of the vagina were treated with transvaginal sacrospinous ligament colpopexy between 1986 and 1990. Nine of them had a posthysterectomy vaginal prolapse; 16 had complete genital prolapse and coincident vaginal hysterectomy was performed. The operation was performed under spinal anesthesia in all cases except one with general anesthesia. Simultaneous anterior colporrhaphy was done in 88%, repair of enterocele in 72% and posterior colpoperineorrhaphy in 88% of all cases. There were no intra- or post-operative complications. Vaginal vault prolapse did not recur during a mean follow-up period of 2.8 years in 22 cases. Three patients developed asymptomatic cystocele or enterocele, and 5 (23%) women had a curtailed vagina. Sacrospinous ligament colpopexy under regional anesthesia is an effective and suitable operation for aged women with vaginal vault and complete genital prolapse. The operation is also a safe and fairly simple procedure if the anatomic relationship of the nearby structures is known.

Aged↗
PubMedDate not supplied

Urethral prolapse in a woman in her reproductive age--a very rare occurrence.

BACKGROUND: Urethral prolapse is a rare condition occurring in prepubertal girls and postmenopausal women. Even most rare is that occurring in the reproductive age grade. METHOD: A report of a woman in her reproductive age who presented in the gynaecology clinic of a private hospital is presented together with a brief review of the literature. RESULTS: Urethral prolapse associated with uterovaginal prolapse, lower abdominal pain and dysuria in a 48-year old grand multiparous (para 8 + 0) farmer who is still observing her monthly menstrual cycle was seen. Her pregnancies and deliveries were unsupervised. A urine culture revealed moderate growth of Escherichia coli sensitive to ciprofloxacin. The urethral prolapse resolved satisfactorily on this. CONCLUSION: It is advocated that antenatal care, education and women empowerment be made a priority. This will almost eradicate this very rare condition in our society.

Female↗
PubMed2006

Complete rectal prolapse clinical and functional outcome with Delorme's procedure.

INTRODUCTION: Many surgical techniques -both through the perineal and abdominal routes- have been described for the treatment of rectal prolapse. The aim of this work is to evaluate the clinical and functional outcome with Delorme's perineal procedure. PATIENTS AND METHODS: Twenty-one patients with complete rectal prolapse were studied from July 2000 to October 2005. Age, gender, anesthetic risk, and accompanying symptoms were all assessed. Diagnostic tests performed included: colonoscopy, anorectal manometry before and after surgery, and 360 masculine endoanal ultrasonography. Delorme's procedures were carried out by only one surgical team. RESULTS: No mortality occurred, and morbidity was minimal. Prolapse relapse rate was 9.52% with a mean follow-up of 34 months. Anal continence improved in 87.5% of patients, and no surgery-associated constipation ensued. Mean hospital stay was 2 (range 1-4) days. During the postoperative period no pain developed in 17 patients, and 4 patients had mild pain. Satisfaction with surgery was high in 16 cases (76.19%), moderate in 3 (14.28%), and low in 2 (9.52%). CONCLUSIONS: Delorme's procedure for the management of complete rectal prolapse is associated with low morbidity, improves anal continence, gives rise to no postsurgical constipation, and has an acceptable relapse rate. Patient satisfaction with this procedure is high because of its high comfortability (intradural anesthesia, short hospital stay, and little postoperative pain) and optimal results.

Adult↗
PubMed1999

Prolapse of the neovagina in Mayer-Rokitansky-Kuster-Hauser syndrome. A case report.

BACKGROUND: Mayer-Rokitansky-Kuster-Hauser syndrome is a rare entity. The creation of a sigmoid vagina was performed in some patients with this syndrome in the past, though it is not widely used now. We report on a patient who developed prolapse of a sigmoid vagina 33 years after the operation. CASE: A 57-year-old woman presented with a "falling-out" sensation in the vagina, pain, leukorrhea and dyspareunia. She had undergone an operation for creation of a sigmoid vagina 33 years earlier in our hospital. She and her husband desired conservation of the ability for sexual intercourse. The transabdominal method of retroperitoneal sacropexy of the sigmoid vagina was performed. The patient has maintained a satisfactory sexual life with her husband since the operation. CONCLUSION: There are a few cases of prolapse of a sigmoid vagina in the literature, while the repair methods are not described in detail. To our knowledge, this is the first report of reconstruction of a sigmoid vaginal prolapse. Although the reasons for the neovaginal prolapse were not understood, the retroperitoneal sacropexy was successful in this case.

Bioprosthesis↗
PubMedDate not supplied

Mitral valve prolapse: gender differences in evaluation and management.

Mitral valve prolapse is a common clinical disorder that affects approximately 3-4% of the adult population. Prolapse occurs more commonly in women and has been associated with a variety of cardiac complications including mitral regurgitation, endocarditis, arrhythmias, and sudden death, as well as noncardiac manifestations including stroke. Much of our earlier understanding has been influenced by significant referral biases and lack of controlled studies. Our understanding of mitral prolapse has evolved considerably since the initial descriptions nearly 3 decades ago. This review on the current knowledge regarding diagnosis and management of primary mitral valve prolapse focuses on gender-related issues that influence clinical presentation, prognosis, and therapeutic strategies.

Adult↗
PubMed2000

Laparoscopic extraperitoneal sacrospinous suspension for vaginal vault prolapse.

BACKGROUND: A new laparoscopic sacrospinous suspension procedure is described for the correction of vaginal vault prolapse using an extraperitoneal approach. This is the first report in the literature of the extraperitoneal approach. METHODS: We reviewed 12 women who had been treated in our hospital using this technique because of vaginal vault prolapse. These women had undergone hysterectomies (10 abdominal; 2 vaginal) between 5 and 22 years previously (mean, 12 years). After pre-laparoscopic preparation, a 10-mm trocar with a 10-mm zero-degree telescope was placed into the Retzius space. Using a direct air-distended method with a 20 mmHg insufflation pressure, Retzius and para-rectal spaces were created. The sacrospinous ligament could be easily identified and confirmed. A permanent suture was then inserted from the sacrospinous ligament to the vaginal vault to ensure that there was no space in between. RESULTS: This procedure was followed for all 12 patients. There were no major complications during surgery. Eleven women had no recurrence of vaginal vault prolapse during a follow-up period of 1 to 3 years (mean, 2.2 years). One patient developed recurrent vaginal vault prolapse; however, she subsequently underwent a successful colposacropexy by laparoscopy 23 months after the initial surgery. CONCLUSION: We modified the traditional sacrospinous fixation laparoscopically, following principles to restore the correct anatomic position of the vault. Laparoscopic extraperitoneal sacrospinous suspension can eliminate the procedure of opening and closing the peritoneum and avoid interference with the intestine during surgery. It can be used as an alternative to traditional genital suspension surgeries.

Aged↗
PubMed2000

[Prevention of vaginal prolapse in patients undergoing abdominal hysterectomy].

BACKGROUND: In our study we evaluate a personally developed surgical technique that, when used for abdominal hysterectomy, helps prevent posthysterectomy vaginal wall prolapse. METHODS: We have used this modified surgical procedure in 244 consecutive abdominal hysterectomies performed from January 1973 through December 1986, compared with 133 abdominal hysterectomies performed without this new procedure. Patients returned monthly and annually thereafter for follow-up. The longest follow-up period to date is 12 years. RESULTS: Of the 244 patients in our study followed up for 12 years, 234 (95.9%) retained excellent vaginal support. Vaginal wall prolapse occurred in 10 patients (4.1%), and it was asymptomatic prolapse, with the vaginal wall descending less than halfway from the ischial spines to the hymen. CONCLUSIONS: This procedure is an acceptable method to help prevent posthysterectomy vaginal wall prolapse.

Adult↗