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PubMed1990

[Pregnancy and labor in women with mitral valve prolapse].

In a prospective study the authors investigated 30 pregnant women (mean age 27 +/- 5.5 years) with prolapse of the mitral valve confirmed on echocardiography, without significant mitral regurgitation, in order to assess whether mitral valve prolapse is a risk factor for the development of complications during gestation and childbirth. As control served a group of 30 healthy pregnant women of corresponding age and number of previous pregnancies, incidence of complications during pregnancy, the type of delivery, sex, length, weight and maturity of the neonates. In women with mitral valve prolapse the authors recorded a significantly higher incidence of subjective complaints such as palpitations associated in 7 of 8 cases with sinus tachycardia 110-140/min. at rest and with vasovagal syncopes. The palpitations were always favourably influenced by beta-blocker therapy or by calcium antagonists. Mitral valve prolapse without haemodynamically significant mitral regurgitation during pregnancy is not a significant risk factor for the development of complications.

Adult↗
PubMed1990

[Disorders of cardiac rhythm in combined ventricular pre-excitation syndrome and primary mitral valve prolapse].

Primary prolapse of the mitral valve was diagnosed in 27 (11.7%) out of 230 patients with preexcitation syndrome: 10 of them presented with Wolff-Parkinson-White syndrome, 15 with Clerc-Lévy-Critesco syndrome, and two patients with combination of both syndromes. Preexcitation syndrome combined with mitral valve prolapse manifested itself by different disorders of the cardiac rhythm, mainly by the supraventricular forms: by PST in 17, nonparoxysmal tachycardia in 1, atrial fibrillation paroxysms in 7, sinus tachycardia in 2, supraventricular extrasystole in 3, pacemaker migration in the atria in 1 patient. Clerc-Lévy-Critesco syndrome initiated with atrial fibrillation paroxysms in 7 patients with mitral valve prolapse and with the enlargement of the left atrium. The prognostically unfavourable varieties of the preexcitation syndrome and mitral valve prolapse manifested themselves in ventricular tachycardia progressing to ventricular fibrillation, paroxysmal supraventricular tachycardia with a high frequency of ventricular contractions up to 213-230 and atrial tachyarrhythmia up to 250-280 per minute, which were regarded as factor at risk for potential transformation to ventricular tachycardia; as well as in continuously recurrent attacks of arrhythmia in the presence of multiple AV additional tracts or combined with sinoatrial and atrioventricular block.

Adolescent↗
PubMed1990

[On the mechanisms of mitral regurgitation in rheumatic mitral valve disease: with special reference to the role of mitral valve prolapse].

To assess the role of mitral valve prolapse (MVP) in the pathogenesis of mitral regurgitation (MR) in rheumatic mitral valve disease (RMD), we performed phonocardiography (PCG), transthoracic and transesophageal two-dimensional and color Doppler (CD) echocardiography in 22 patients with RMD including three with pure mitral stenosis (MS), 11 with predominant MS, six with predominant MR and two with pure MR. Results were as follows: 1. Prolapse of the mitral valve (MV) was differentiated from systolic ballooning of the whole MV by the findings that the anterior leaflet's tip (rough zone) protruded into the left atrium with an acute angle between the body (clear zone) and rough zones of the anterior MV and that the posterior leaflet protruded markedly above the level of the mitral ring. 2. MR was detected in six patients (slight MR) by only the CD method and in 13 (mild, moderate or greater MR) by both the PCG and CD methods. 3. MR was absent or slight in five patients (three of pure MS and two of predominant MS) without valve thickening and with systolic ballooning of the whole valve due to commissural fusion. 4. Mitral valve abnormalities related to significant (mild, moderate or severe) MR were dependent on valve thickening (five patients), prolapse of the leaflet's tip toward the left atrium (four), or both (four). 5. An apical systolic click was found in only one of the nine patients with systolic ballooning, but in four of 11 with MVP. 6. The MR murmur in six of the nine patients with valve thickening showed the decrescendo or flat contour, but that in four of the eight patients with MVP showed a crescendo contour. From these results, we concluded that mitral valve prolapse should be considered as one of the important causes of mitral regurgitation in rheumatic mitral valve disease.

Adult↗
PubMed1989

[Innervation of the mitral valve in normal and prolapsed mitral valves].

To evaluate the relationship between mitral valve prolapse (MVP) and autonomic nerve dysfunction, clinical and immunohistochemical studies were performed. I. Clinical study Autonomic function tests and supine bicycle exercise were performed in 60 patients with MVP, 41 under 35 years of age and 19 of 35 years and older, and the results were compared with those of 31 normal controls, 19 under 35 years of age and 12 of 35 years and older. Case with positive response on postural stress and cold pressor tests were more frequent in both MVP groups than those of controls. Plasma nor-adrenaline levels were higher in the MVP groups than in the control groups during exercise. Our clinical observation suggested that autonomic dysfunction, particularly sympathetic hyperactivity, probably is present in MVP irrespective of age. II. Immunohistochemical study In 23 mitral valves (15 of normal controls and eight of MVP), three normal tricuspid, three normal aortic and three normal pulmonic valves, immunohistochemical localizations of S-100 protein, glial fibrillary acidic protein (GFAP) and neurofilament protein (NFP) were examined to detect the distribution of all nerve endings, choline acetyltransferase (ChAT) to detect the distribution of cholinergic nerve fibers, and neuropeptide Y (NPY) and calcitonin gene related peptide (CGRP) to detect the distribution of afferent nerve fibers, using the avidin-biotin peroxidase complex (ABC) method. The distribution of adrenergic nerve fibers was examined by fluorescence with the glyoxylic acid method. In normal valves, S-100 protein was mainly demonstrated in the base and body of the valve cusp. It was very scanty in the tip, and was only found in the coaptation zone that is, the layer of the atrialis or along the boundary between the atrialis and the spongiosa in the atrioventricular valves. The distribution of S-100 protein in the prolapsed mitral valve was the same as that of the normal valve except for the lack of S-100 protein in the degenerated portion. The distribution of GFAP, NFP, ChAT, NPY, CGRP and adrenergic fluorescence were the same as that of S-100 protein in both the normal and prolapsed mitral valves. It is suggested that the above-mentioned anatomical distribution of the nerve in the mitral valve is closely related to the dysfunction of the autonomic nerve system in the condition of mitral valve prolapse, because the body of the mitral valve is rich in nerve endings and this area is most easily influenced by the mechanical stimulation due to abnormal coaptation.

Adult↗
PubMed1989

Treatment of complete rectal prolapse with foreign material.

The results of treatment of complete rectal prolapse with Teflon mesh repair are described in 64 patients. Adequate fixation by posterior rectopexy was reached in all patients. In 23 per cent of the patients postoperative constipation was noticed that could adequately be managed with laxatives in most instances. After a mean follow-up of 30 months, none of the patients had complete recurrences. Four patients had new complaints of prolapse. These complaints were two times based on haemorrhoids, two other patients had a small mucosal prolapse. Modified Teflon mesh repair is recommended as a safe method to manage rectal prolapse with a high rate of success.

Adolescent↗
PubMed1989

[Mitral valve prolapse and cerebral ischemia].

We report on 10 patients suffering from cerebral ischemic episodes in whom mitral valve prolapse was diagnosed. Neurologic assessment included computerized tomography and angiographic study. In one case, the angiographic study revealed the presence of intracranial vasculitis and one woman was taking the contraceptive pill. The diagnosis of mitral valve prolapse was established on the basis of clinical grounds and electrocardiographic, Doppler study, Holter monitoring and two-dimensional echocardiographic signs. Our findings confirm that mitral valve prolapse is an etiologic factor to be considered in young adults with cerebral ischemia, although mitral valve prolapse does not exclude the possibility of other etiopathogenic conditions occurring.

Adolescent↗
PubMed1989

Symptomatic mitral valve prolapse in children and adolescents: catecholamines, anxiety, and biofeedback.

It has been proposed that symptomatic mitral valve prolapse may be associated with a hyperadrenergic state and/or increased anxiety. To test this hypothesis, Spielberger State-Trait Anxiety (STAI) scores and 24-hour urinary catecholamine collections were gathered from 11 children and adolescents without mitral valve prolapse, 6 with asymptomatic mitral valve prolapse, and 14 who had chest pain (some with additional symptoms of shortness of breath, palpitations, and fatigue). STAI scores and catecholamine excretion values were not significantly different between groups. Ten symptomatic patients were randomly assigned to either eight sessions of skin temperature biofeedback with daily home practice of relaxation-mental imagery techniques or an attention-placebo condition. Change in 24-hour urinary catecholamine excretion values and STAI scores from baseline to end of treatment did not differ significantly between treatment and placebo conditions. Although not evident at the end of treatment, a significant decrease in chest pain was found in the biofeedback group at 6-month follow-up evaluation. In summary, results of this study did not show evidence of increased sympathetic tone or levels of anxiety in symptomatic pediatric patients with mitral valve prolapse. A behavioral treatment program using biofeedback and relaxation-mental imagery techniques was associated with decreased chest pain at 6-month follow-up.

Adolescent↗
PubMed1989

Mitral valve prolapse: an overview.

Since its original description by Barlow over a quarter of a century ago, mitral valve prolapse has become one of the commonest heart diseases around the world. It is commoner in women than men, in thinner than heavier subjects, and in younger than older persons. A unifying concept of a valvular-ventricular disproportion serves to explain the various conditions in which mitral valve prolapse occurs. The etiology of chest pain which is the most frequent symptom that brings the patient with mitral valve prolapse to a physician is multifactorial. Diagnosis of mitral valve prolapse is based on clinical grounds chiefly by careful auscultation. Echocardiography, angiocardiography, and radionuclide ventriculography are valuable adjuncts. Prognosis in the majority is excellent except when complications occur, such as progressive mitral regurgitation, infective endocarditis, cerebral ischemic episodes, and sudden death. For mitral valve surgery repair is preferred to replacement.

Adult↗
PubMed1989

Rectal prolapse in children.

Rectal prolapse in children is nowadays a rare anomaly. Potty training in young children is the common cause and the resulting prolapse can be treated conservatively. In children with refractory prolapse, sclerosing injections may be used. Operative treatment by posterior rectopexy is only indicated in the very few cases of long-standing prolapse.

Adolescent↗
PubMed1989

[Benignancy of the Delorme operation in the treatment of rectal prolapse. Indications and results].

In five patients, three male and two female (average age 74 years), with complete rectal prolapse, Delorme's operation was performed, realizing resection of the entire prolapsed rectal mucosa and the suturing the plicature of the rectal muscular layer, which permits its invagination into the muscular funnel formed by the outer sphincter. This technique, which also tenses the longitudinal muscle of the rectum that is lax in every total prolapse, partially remedies the dislocation of the hiatal ligament and improves the function of the elevator muscle, which is disordered in these patients. The five patients were followed-up for 3 to 36 months. There was no postoperative morbi-mortality in patients of advanced age or high risk had to be operated for rectal prolapse.

Aged↗
PubMedDate not supplied

[Prolapse of the mitral valve. Study using bidimensional echocardiography].

Mitral valve prolapse is frequent in childhood. The use of two-dimensional echocardiography may enable more accurate diagnosis and assessment of the degree of valve involvement. Twenty five (1.9%) of all children studied by two-dimensional echocardiography fulfilled the diagnostic criteria for mitral valve prolapse. In 48% it was associated to a different congenital heart as normality. The apical four chamber and parasternal long and short axis views were used, and cases were graded according to the severity of the prolapse. Diagnosis was made in 44% of cases by the apical four chamber view, which was the best projection to detect the abnormality. Cases of moderate and severe prolapse were also detected in the parasternal long axis view. All patients were asymptomatic but they were all controlled detect progression to mitral insufficiency of the appearance of other complications.

Adolescent↗
PubMed1989

[Transesophageal echocardiographic findings of mitral valve prolapse].

Transesophageal echocardiography (TEE) is a new approach to the investigation of the heart, at a closer range without interference from lung tissue or ribs. In this study, we evaluated 15 patients with mitral valve prolapse by TEE. All patients had a pansystolic murmur and severe mitral regurgitation by left ventriculography. Seven patients underwent cardiac surgery. The presence of ruptured chordae tendineae was confirmed in all these patients at the time of operation. The transesophageal echocardiographic finding of mitral valve prolapse was a circular or coiled cusp or whip-like protrusion of a scallop into the left atrium in systole. TEE disclosed ruptured chordae tendineae in all of the seven patients with ruptured chordae tendineae confirmed by surgery, whereas transthoracic echocardiography disclosed only one. In the remaining patients, TEE disclosed chordal rupture in six. The prolapsed sites by TEE were coincident with those by cardiac surgery in each patient. By three-dimensional construction of the mitral valve using TEE, the direction of mitral regurgitant jet was correctly visualized. In conclusion, TEE is useful in evaluating patients with mitral valve prolapse and is a sensitive method for detecting ruptured chordae tendineae.

Chordae Tendineae↗
PubMed1988

Follow-up observations in patients with mitral valve prolapse.

The discrepancies reported in various studies with respect to long-term prognosis in mitral valve prolapse can be attributed to the criteria employed for diagnosis and to the differing patient populations studied. Furthermore, mitral valve prolapse is not a single, well-defined disease but reflects rather a broad spectrum of a disease process. Echocardiographically, patients can be identified with redundant, thickened leaflets with excessive mitral valve motion and prolapse as well as those with normal appearing leaflets but systolic prolapse representative of differing disease processes with differing prognosis. The incidence of sudden cardiac death is estimated at a low value of 1.9/10,000 patients per year. In the presence of a normal resting ECG, with no hemodynamically-meaningful mitral regurgitation and no evidence of redundant mitral leaflets the risk is even less. Cerebral embolic events occur with an estimated incidence of 1/6000 patients per year, similarly low; it can be assumed that patients with very myxomatous, redundant mitral leaflets have the highest risk. The incidence of infective endocarditis is also low, estimated at 1/5725 patients per year (0.175%). Risk factors for complications include: a systolic murmur, advanced age, male sex and leaflet redundancy. The most important complication is mitral regurgitation for which the incidence is highest in older men and in the presence of left ventricular, dilatation.

Cerebrovascular Disorders↗
PubMed1986

[Mitral valve prolapse and pectus excavatum. Expressions of connective tissue dystrophy?].

Pectus excavatum is a common malformation in diseases of elastic tissue (Marfan, Ehlers-Danlos...). When observed apparently alone it may represent a minor form of dystrophy, implying the same risk of a cardiac lesion. Abnormalities of the thoracic skeleton and echocardiographic mitral valve prolapse is a well established association, suggesting a common disorder of connective tissue. However, there is no absolute proof that this is a statistically significant association. Histological connective tissue changes relating these two markers have yet to be found. Clinical and echocardiographic examinations and skin biopsies were performed in 17 patients with pectus excavatum. Mitral valve prolapse was detected in 65% of cases (associated in 1 out of 3 cases with tricuspid valve prolapse). In 53% of cases electron microscopy showed abnormal skin collagen and elastin. Collagen abnormalities were twice as common as those of elastin and could be associated. Mixed changes of thinning of elastin and collagen fibres of irregular calibre were particularly suggestive. Pectus excavatum would therefore seem to be the expression of a minor form of dystrophy of collagen and elastin tissues and a clinical marker of possible mitral valve prolapse.

Adult↗
PubMed1985

Modified Thiersch operation for rectal prolapse. Technique and results.

Rectal prolapse is best treated by intra-abdominal or perineal procedures that either resect the redundant rectosigmoid colon or fix the rectum within the pelvis. We have found the Thiersch procedure to be adequate treatment in patients who are high risk or who have only mild to moderate prolapse of the rectum. Over the past 20 years, we have treated 15 patients with a modified Thiersch procedure, using a knitted Dacron vascular graft to encircle the anus. One patient required a second Thiersch procedure after failure of a Ripstein procedure that followed failure of a Thiersch procedure done with wire. A second Thiersch procedure was required in two patients after suture breakage, and in one patient after removal of an infected graft. Two other patients had graft infections necessitating removal of the Dacron graft; one patient had a perianal infection that was treated without removing the graft. Continence was achieved in six of nine patients previously incontinent, and maintained in the six patients who had been continent before operation. Prolapse was corrected in 13 of the 15 patients. Although the Thiersch procedure is not applicable to all patients with rectal prolapse, it can be used successfully when performed properly.

Aged↗
PubMed1988

Exercise left ventricular performance in patients with mitral valve prolapse.

Patients with mitral valve prolapse may, even in the absence of associated coronary artery disease or significant mitral regurgitation, have abnormality in exercise left ventricular function. The precise reason for this abnormality, which appears to be age and sex related, is not clear. Abnormal ejection fraction response to exercise cannot be predicted by the nature of symptoms, electrocardiographic changes, arrhythmias, or by extent and severity of mitral valve prolapse by echocardiography. Caution should therefore be exercised in diagnosing associated coronary artery disease based on the ejection fraction response to exercise per se or even on exercise-induced wall motion abnormality. Patients with prolapse, have reduced exercise tolerance, which has been ascribed to reduced left ventricular filling and smaller left ventricular end-diastolic volume in the upright position. Patients with mitral valve prolapse and associated coronary artery disease or significant mitral regurgitation often have, as expected, abnormal left ventricular function during exercise.

Adult↗
PubMed1988

[A new diagnostic criteria of mitral valve prolapse syndrome].

The diagnosis of mitral valve prolapse (MVP) should depend on the presence of significant mitral regurgitation or mitral complex abnormality as far as MVP is a diseased status. Concerning the echocardiographic diagnosis, the site of prolapse is difficult to determine correctly. In this study, Doppler color flow mapping was used to detect mitral regurgitation, and to decide the site of prolapse. Our new criteria of MVP include: (1) Phonocardiographic or auscultatory findings suggestive of mitral regurgitation or mitral complex abnormality. (2) A systolic bulging or an apparent systolic ballooning of the mitral valve by two-dimensional echocardiography. (3) A mitral regurgitant signal with an acceleration flow at the site of prolapse by Doppler color flow mapping.

Echocardiography↗
PubMed1988

Fallopian tube prolapse after hysterectomy. A report of two cases.

Two patients were treated for fallopian tube prolapse after abdominal hysterectomy. This rare complication is usually seen after vaginal hysterectomy. Our patients presented with a profuse, blood-tinged vaginal discharge and lower abdominal pain two and three months after hysterectomy. The tender, fimbriated end of the fallopian tube must be distinguished from common cuff granulation tissue, one patient underwent painful cautery treatments for over a year before the correct diagnosis was made. Biopsy of the prolapsed tissue in both cases failed to provide the correct diagnosis. In cases reported on previously, repair of the prolapsed tube usually was accomplished transvaginally, but in one of our patients laparotomy was required to control bleeding from the retracted proximal tube. The other patient had her prolapsed tube diagnosed and resected laparoscopically. This technique, described in detail, has the advantage of avoiding more-extensive surgery in selected cases.

Adult↗