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PubMedDate not supplied

Mitral valve prolapse: a study of 45 children.

The knowledge pertaining to mitral valve prolapse is mainly based on studies in adults. In this study, the clinical profile as described in adults was compared with that found in children up to the age of 13 years. Forty-five children with echocardiographic-proven mitral valve prolapse and who met the inclusion criteria were included in the study. The male:female ratio in this study was 1:1.37 and was not statistically significantly different from reported ratios. Most of the children were asymptomatic. Twenty-one of the 31 patients referred from outside the hospital had an incidentally found murmur. The symptoms found in this study were not similar to those described in adults. The most commonly found symptoms were shortness of breath and fatigue, in contrast to those of chest pain and palpitations described in adults. Comparing males to females in this study, significantly lower weight (p = 0.005) and body mass index (p = 0.003) were found in girls, and a significantly lower pulse rate (p = 0.002) in boys. Left-sided cardiac enlargement was diagnosed in 11 patients on chest X-ray and in six patients on electrocardiogram. One patient had Marfan syndrome and four others had a Marfanoid appearance. In conclusion, most children with mitral valve prolapse are asymptomatic. Mitral valve prolapse is not an uncommon finding in children younger than 13 years of age. Patients with mitral valve regurgitation were advised to take infective endocarditis prophylaxis prior to invasive procedures.

Adolescent↗
PubMed2003

Total colpocleisis for severe pelvic organ prolapse.

OBJECTIVE: To describe the complications and efficacy of total colpoclesis for severe pelvic organ prolapse. STUDY DESIGN: In this descriptive study, we analyzed the complications and efficacy of total colpoclesis in 41 consecutive women with pelvic organ prolapse at Temple University Hospital between November 1994 and June 2001. RESULTS: The mean followup period was 28.7 months (range, 5-65). Vaginal hysterectomy was performed in 12 patients. All but 10 patients underwent concomitant modified paravaginal cystourethropexy. Modified perineorraphy was standard in every case. There was no recurrence of prolapse and a very low complication rate. The cure rate for urinary incontinence was 53.1% in 32 patients with preoperative urinary incontinence. CONCLUSION: Total colpocleisis combined with site-specific reconstructive surgery is an effective and safe treatment of severe pelvic organ prolapse in high-risk, elderly women.

Aged↗
PubMed2003

Mitral valve prolapse: an atypical variation of the anatomy.

BACKGROUND: The mitral valve apparatus is a complex structure composed of an annulus, mitral leaflets, chordae tendinae, papillary muscles and left ventricular, atrial and aortic walls. Deficiency or degeneration of one or more of these structures may result in dysfunction of the valvular apparatus leading to mitral valve prolapse during systole. OBJECTIVE: To review the chordal attachment of surgically resected mitral valve tissue from cases of mitral valve incompetence. METHODS: The clinical and morphological features of 135 surgically resected posterior mitral valve leaflet specimens were reviewed for mitral valve prolapse from January 1999 to June 1999. Four mitral leaflets removed either surgically or at autopsy served as controls. RESULTS: Excised posterior mitral leaflets from two patients had segments containing free margin and rough zone chordae that lacked attachment to larger 'strut' or 'stem' chordae or to either papillary muscle. These chordae were observed in otherwise normal mitral valves with adjacent areas that had normal chordal arrangements. Such chordae of the posterior leaflet were termed 'atypical chordae tendinae'. There was no good gross or histological evidence of chordal rupture, and this atypical arrangement appears to be congenital in origin. Grossly and histologically, these atypical variants otherwise exhibited characteristics similar to those of leaflet tissue from typical cases of mitral valve prolapse, with shiny, grey-white and "edematous" tissue that contained increased mucopolysaccharides in the zona spongiosa and chordae tendinae. CONCLUSIONS: This review found atypical attachment of mitral valve chordae tendinae such that isolated segments of the posterior leaflet congenitally lack chordal support, likely leading to mitral valve prolapse. Review of the literature suggests that this is a heretofore unreported cause of mitral valve incompetence.

Adult↗
PubMed2003

Uterine cervical elongation and prolapse during pregnancy: an old unsolved problem.

Prolapse with elongation of the cervix is a rare complication of pregnancy. Prolapse that existed before onset of pregnancy will usually resolve spontaneously by the end of the second trimester, without further complications. A pessary can be used to protect the cervix. Prolapse that develops during pregnancy is usually first noted in the third trimester, and management consists of bed rest in a slight Trendelenburg position. In these cases, pessaries will probably not remain in place or prevent preterm labor. Patient discomfort, urinary tract infection, acute urinary retention, premature labor, and prenatal loss are still major complications, and prolapse usually persists or recurs after labor. Treatment depends on the severity of the condition and the patient's preference.

Female↗
PubMed2004

Is magnesium deficit in lymphocytes a part of the mitral valve prolapse syndrome?

Magnesium deficiency has been proposed to be related to the mitral valve prolapse syndrome. However determinations of magnesium concentration in blood serum and hemolysates of red blood cells in this disease revealed divergent results. We investigated 49 patients with the mitral valve prolapse syndrome and 30 healthy individuals, matched by age and gender. The concentration of magnesium was measured in blood plasma and lysates of lymphocytes isolated from venous blood. The magnesium concentration in plasma was similar in both the patients and the healthy controls. By contrast, the magnesium concentration in lysates of lymphocytes was significantly lower (p < 0.03) in the patients with mitral valve prolapse syndrome than in the controls (range: 1.94-10.6 mmol/g of protein in Lymphocyte lysate; median 5.98 and 6.7-9.61 mmol/g of protein; median 7.22). The results obtained suggest that magnesium deficiency may be part of the mechanisms of the mitral valve prolapse syndrome.

Adolescent↗
PubMed2004

[Abdominal sacral colpopexy in the treatment of posthysterectomy vaginal vault prolapse].

OBJECTIVE: To evaluate the safety and efficacy of the abdominal sacral colpopexy in the treatment of posthysterectomy vault prolapse. DESIGN: Retrospective clinical trial. SETTING: Obstetric and Gynecologic Department, The Charles University 2nd Medical School and Faculty Hospital Motol, Prague. METHODS: A group of 18 patients with vaginal vault prolapse after hysterectomy who underwent abdominal sacral colpopexy between July 2001 and June 2003 was studied. Ten women had undergone previous abdominal and 8 previous vaginal hysterectomy. All patients were operated on by one surgeon. Preoperative evaluation consisted of physical examination, age, parity, body mass index, history of previous pelvic surgery and hormonal status. The cure rate and complications were evaluated in follow-up. RESULTS: The mean age was 59.5 (41-72) years, the median parity was 2.05 (1-5). Seven (38.9%) patients were slightly overweight (BMI 25-30 kg/m2), one (5.6%) patient was obese (BMI 33.4 kg/m2) and 10 (55.5%) had normal weight (20-25 kg/m2). The average period of follow-up was 14.9 months (6-24). The cure rate was 94.4% (17 of 18 patients). No serious intraoperative complications occurred. Postoperative complications occurred in 2 (11.2%) cases (one urgent and one stress urinary incontinence). The complications were resolved and the patients were free of negative postoperative symptoms in the time of the last follow-up visit. CONCLUSIONS: Vaginal vault prolapse is an infrequent complication after both vaginal and abdominal hysterectomy. The study shows that abdominal sacral colpopexy is an effective and safe surgical procedure in the treatment of posthysterectomy vault prolapse. The operative technique is simple but the surgery should be performed by experienced pelvic surgeons able to resolve intraoperative complications.

Adult↗
PubMed2004

[Genital prolapse; treatment and course in four general practices].

OBJECTIVE: To obtain insight into the treatment and course of genital prolapse in four general practices. DESIGN: Historical cohort study. METHOD: The files of patients in whom a prolapse was first diagnosed in the period 1976-2000 and who belonged to the four general practices associated with the General Practice Department of the UMC St Radboud in Nijmegen, the Netherlands, were studied. Data were collected concerning the management, course and symptoms arising from the use of pessaries and complications after operations. RESULTS: 324 patients were included with a median follow-up of 9 years; 15 of them had been treated by a gynaecologist. The initial treatment prescribed by the general practitioner (n = 309) was a wait-and-see policy in 29% of the cases, a pessary (40%), exercises of the muscles of the pelvic floor (15%) or medication (5%). A total of 192 of the 324 patients (59%) received a pessary in the course of time; 47% of them had no problems during the use of a pessary, 17% had increased vaginal discharge and 17% had a pressure ulcer. In 15% of the cases the pessary was ultimately lost because of insufficient support from the pelvic floor muscles. The pessary remained in situ for an average of 5.4 years (SD: 5.4). In 107 (56%) cases it was removed after a period of time; the most important reasons for this were complaints arising from the use of the pessary (54%) and ineffectiveness (24%). In case of a conservative approach (n = 299), the prolapse became worse in 15% of the cases. A total of 128 patients (40%) were referred to a gynaecologist. Of the 92 patients who were operated, 10% experienced a complication and 24% a recurrence. CONCLUSION: The pessary was a frequent and justified treatment in women with a genital prolapse. It is important that the complications of the pessary be reduced further.

Cohort Studies↗
PubMed2004

[Dynamic MRI in the preoperative management of genital prolapse. A prospective study].

Forty-three patients with genital prolapse prospectively underwent blinded pre and postoperative MRI, with dynamic assessment of each compartment. MRI was significantly more accurate than physical examination for the diagnosis of posterior defects (rectocele, enterocele) but not for anterior defects or uterine prolapse (hysterocele, cystocele). Postoperative MRI confirmed the surgical outcome and also identified risk factors for recurrence. MRI was particularly reliable for recurrent prolapse and vault prolapse. The authors consider that dynamic MRI can advantageously replace colpocystodefecography, as it is rapid and well tolerated. Technical improvements should help to understand the role of muscular and fascia lesions.

Female↗
PubMed2005

[Mitral valve prolapse].

It is thought that mitral valve prolapse is the most commonly diagnosed valvular heart disease and affects 3 to 5% of the community. Mitral valve prolapse is commonly a benign disease and the prognosis is good. But it is understood that mitral valve prolapse causes sudden death rarely. As etiologies of their sudden deaths ventricular arrhythmia, mitral valve regurgitation et al. are known. Mitral valve prolapse is brought as the reason of sudden deaths in athletes not a little. Therefore, it is important to follow up them by exercise tolerance test, Holter ECG, ultrasoniccardiography, and chest auscultation et al. and the prescription of beta-blockade et al. and the insertion of implantable cardioverter defibrillator are considered. Moreover, it is important to decide right or wrong of exercise practice.

Death, Sudden, Cardiac↗
PubMed2006

Mitral valve prolapse, atrial flutter, and syncope in a young female patient.

BACKGROUND: The syndrome of mitral valve prolapse (MVP) is the most common form of valvular heart disease. CASE REPORT: The case of a 16-year-old girl with mitral valve prolapse, atrial flutter and syncope is presented. The patient was admitted to the clinic complaining of atypical chest pain, palpitations, breathlessness at physical efforts, fatigue, and a feeling of fogginess. Electrocardiogram showed the presence of the common-type atrial flutter with 3:1 ventricular responses. Echocardiography showed mitral valve prolapse with mild mitral regurgitation. The patient reported to have had these symptoms for about nine months. She was not aware of heart disease before. CONCLUSIONS: A young female patient with combined mitral valve prolapse, atrial flutter, and syncope is presented.

Adolescent↗
PubMed2006

[The role of ethiopathologic approach in pelvic prolapse surgery].

Prior to examining and describing pelvic organ support defects in females, all clinicians should use optimal pelvic prolapse classification. We proposed our original classification which includes both the prolapse grade and etiopathological causes. In our classification crucial point of descent is isthmus of uterus. Such conception will aid in providing a comprehensive and correct surgical treatment to reduce prolapse recurrence. According to ethiopathologic principles in pelvic prolapse surgery, in our study success was obtained in 97.3%.

Algorithms↗
PubMed1992

Long-term functional results of colon resection and rectopexy for overt rectal prolapse.

We reviewed the long-term functional results of colon resection and suture rectopexy for complete rectal prolapse in 47 patients followed for more than 3 yr (mean 65 months). Thirty-three patients underwent sigmoidectomy, eight patients underwent subtotal colectomy, and four patients underwent sigmoidectomy with subsequent subtotal colectomy. Three patients (6.3%) developed recurrent full-thickness prolapse, and four patients (8.5%) developed rectal mucosal prolapse. Twenty patients presented with constipation, 10 (50%) of whom improved after surgery. Constipation improved in seven (70%) patients who underwent subtotal colectomy. Twenty-one patients presented with incontinence, eight (38%) of whom improved. Continence worsened in six patients, and four patients developed significant diarrhea. These complications did not correlate with the extent of bowel resection. Three patients required subsequent stomas. Colon resection and rectopexy provides long-term control of rectal prolapse with an acceptable recurrence rate. Subtotal colon resection is frequently helpful in patients with associated constipation. However, colon resection of any magnitude entails a small risk of chronic diarrhea and/or diminished continence.

Colectomy↗
PubMed1991

Clinical results of abdominal rectopexy for rectal prolapse.

Abdominal Marlex-mesh rectopexy was used for surgical treatment of rectal prolapse in 54 consecutive patients. Anal incontinence was observed in 43 patients (80%) before surgical treatment. The degree of anal incontinence was more severe in women as compared with men. Operative treatment corrected the pathologic anatomy effectively as only one recurrent prolapse developed. At the follow-up examination three patients had symptomless anal mucosal prolapse during maximal straining. 75% of the incontinent patients regained continence for faeces and the rest had some improvement in continence. Seventeen patients (31%) had postoperative constipation, that required lactulose treatment. In conclusion, abdominal Marlex-mesh rectopexy can be recommended as safe and effective treatment for rectal prolapse, despite some patients developing constipation and some remaining incontinent.

Adolescent↗
PubMed1991

[Late potentials in patients with prolapse of the mitral valve].

Recently published reports have highlighted the presence of a high incidence of late potentials in patients with mitral valve prolapse. In order to verify this observation 29 patients suffering from this pathology were studied using high-resolution electrocardiography. Late potentials were present in 24% of patients with mitral valve prolapse in comparison to 5% of control subjects (p less than 0.05); no correlation was found however in patients with mitral valve prolapse between the presence of late potentials and Holter's ventricular hyperkinetic tachycardia. At a follow-up after 16 +/- 4 months no patient presented persistent ventricular tachycardia or sudden death. The presence of late potentials might be yet symptom of the mitral prolapse syndrome whose prognostic role, although not yet clear, does not appear to represent a negative factor in relation to major tachycardia attacks.

Arrhythmias, Cardiac↗
PubMed1991

Management of rectal prolapse in Ile-Ife, Nigeria.

Complete rectal prolapse is uncommon in adults. Out of 129,525 patients treated at our teaching hospital over a five-year period, only 29 patients were managed with complete rectal prolapse. The total mean-age was 52 years with an approximate 1:2 male-female ratio. Two of the patients had their prolapse for 16 years before presentation. Major clinical features included constipation, diarrhoea, soiling and rectal bleeding. 51.72% of the cases had partial to complete incontinence of faeces. 22 patients were treated with the simple technique posterior fixation of both rectum and sigmoid colon. Follow-up was from 6 months to 4 years, mortality was 3.44%. There had been no recurrences of the complete rectal prolapse to date.

Adult↗
PubMed1991

[Genital prolapse in Dakar].

Genital prolapses are the result of musculo-ligamentary alterations often caused or complicated by traumatic delivery and senible atrophy of the tissues. From 1969 to 1988, we gathered 104 files of patients with genital prolapses. The age of the patients ranged from 20 to 70 years with an average age of 30. The subject between the ages of 20 and 39 were the most affected (64%). The average number of children per woman was 4. 60 patients had 5 children. No case of prolapses was found among virgin or mulliparous women. In 48 cases delivery was dystocic. The clinical symptomatology was a feeling of intravaginal globus, pelvic algia and discomfort (57 cases). Straingul urinary incontinence wax manifest in 15 patients. Colpocystocele (88 cases), rectocele (66 cases) and hysterocele (50 cases) were among the most frequently evidence lesions. On the therapeutic matter, the low passage was used 58 times and the high passage 32 times. An urinary gesture was made 33 times. There was no operatory fatality. Urinary troubles related to infection, acute retention of urine and strainful urinary incontinence were observed. Later 10 cases of recurrence were observed within an average time interval of 2 years. This work is characterized by the young age of the patients. It denotes the noticeable role played by obstétrical traumatisms in the genesis of genital prolapses in the African context. The senescence and atrophy of the tissues seem to have a less important role in contrast with the developed countries. Finally, the surgical treatment of these patients must take into account, among other things, the child bearing desire of the patients, given the social and psychological weight of maternity in our society.

Adult↗
PubMedDate not supplied

[Infectious endocarditis in mitral valve prolapse].

The paper reports on 13 cases of infectious endocarditis in the patients with prolapse of the mitral valve admitted for a period of 10 years (1979-1989) into the Clinic of Cardiology of the Fundeni Hospital. These cases stand for 3.6% of the cases with prolapse of the mitral valve admitted during that period, and 5% of the patients with infectious endocarditis. Our study dealt only with the cases of the prolapse of the mitral valve, clinically and echographically documented before the appearance of the septic graft. The hemocultures were positive in all the patients (viridans streptococci in 84.61% cases). The symptomatology, the clinical objective data and the paraclinical results (phonocardiographic, echocardiographic, electrocardiographic, radiologic, investigations with isotopes), the response to the treatment (medical, surgical) and the evolution in time were analyzed. An increase was found during endocarditis in the number of patients with holosystolic murmurs (30.7% cases) versus those with click-telesystolic murmur, the appearance in 41.15% of the cases of valvular vegetations at the Echo examination, and in 15.38% cases of ruptures of cordages. Mitral insufficiency secondary to endocarditis became worse, in 30.76% cases. The treatment with antibiotics resulted in the healing of the infection in all the cases. The surgery was not necessary in any patient during the evolution of endocarditis. The surgery (valvular prosthesis) was made in 23.07% cases, which presented, after curing the septic graft, important mitral regurgitation with cardiac insufficiency refractory to the medical treatment. Prophylaxis of the infectious endocarditis in the prolapse of mitral valve with mitral regurgitation is necessary.

Adult↗
PubMed1991

Abdominal-retroperitoneal sacral colpopexy for the correction of vaginal prolapse.

Complete genital or vaginal prolapse affects a large number of middle-aged to elderly females. Satisfactory correction of prolapse with maintenance of vaginal patency has been a challenge to the pelvic surgeon for many years. We present a retrospective review of 147 patients undergoing abdominal sacral colpopexy using dacron graft or expanded polytetrafluoroethylene. The anatomical basis of repair, operative technique, and results are described. Ninety-three percent of the patients experienced long-term success over 5 years, including those with previous failed repairs. Both short- and long-term complication rates were acceptable. Only four patients experienced graft erosion, and only one of those had recurrent prolapse. Abdominal sacral colpopexy offers those affected with genital prolapse an opportunity for long-term relief, with maintenance of a patent vagina.

Abdomen↗