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PubMed1987

[Mitral valve prolapse in patients with anorexia nervosa].

Mitral valve prolapse was echocardiographically examined for 23 female patients with anorexia nervosa. The age was ranged from 13 to 26 and averaged 19.6 years. Their body weights ranged from -25 to -45% of the ideal body weights. Mitral valve prolapse was detected in 19 (83%) cases. The involved valve leaflets were anterior and posterior in 10 and anterior in nine cases, and significant bradycardia was present in the former. Left ventricular end-diastolic dimension was less than the control subjects. The follow-up study in five patients disclosed that each prolapse was unchanged despite of the significant improvement of the disease. The involved mechanism of prolapse in patients with anorexia nervosa was discussed in the light of vagotony based on the pharmacodynamic tests and the results of the previous experimental works of Imataka et al.

Adolescent↗
PubMed1987

[Relationship of two-dimensional echocardiographic mitral valve prolapse to mitral regurgitation assessed by color Doppler flow imaging].

Although two-dimensional echocardiography is a standard for diagnosing mitral valve prolapse, the diagnostic criteria are controversial. Regardless of valve ballooning we have used our criteria which are based on the dislocation of the mitral valve coaptation. The purpose of this study was to clarify the relationship between the location and the degree of mitral valve prolapse assessed by two-dimensional echocardiography and those of mitral regurgitation evaluated by color Doppler flow imaging, which enables us detailed analysis of regurgitation. Twenty-three patients with idiopathic mitral valve prolapse diagnosed by our criteria were studied. They were 14 men and nine women, ranging in age from 19 to 72 years (mean 44.7). In any patients, prolapse of either the anterior or posterior leaflet does not satisfy the Gilbert's criteria. Twenty of the 23 patients had mitral regurgitation by color Doppler flow imaging, and the grade was II, III or IV in 16 of these 20 patients. In 19 of 20 patients, the localization of the regurgitant jet flow from the mitral orifice coincided with the two-dimensional echocardiographic site of dislocation of mitral valve coaptation. Therefore, it was concluded that the dislocation of mitral leaflet coaptation detected by two-dimensional echocardiography is an abnormal finding regardless of the protrusion of the valve beyond the mitral ring.

Adult↗
PubMedDate not supplied

Mitral valve prolapse in systemic lupus erythematosus.

Despite a low incidence of clinical manifestations, autopsy data suggest endocardial and myocardial disease in about 50% of patients with systemic lupus erythematosus. To investigate whether mitral valve prolapse can be considered a clinical manifestation of cardiac involvement in systemic lupus erythematosus, we carried out an echocardiographic study in 51 affected subjects and 102 normals matched for age and sex. Prevalence of mitral valve prolapse was 25% in patients with systemic lupus erythematosus and 9% in healthy controls with a statistically significant difference (p less than 0.01). Neither pericardial effusion nor prolonged (more than 12 months) treatment with corticosteroids were associated with higher prevalence of mitral valve prolapse. Libman-Sacks verrucae on the mitral valve apparatus as well as focal myocardial scars affecting the papillary muscles and adjacent myocardium could be responsible for the development of the valvular dysfunction. We suggest that mitral valve prolapse can be considered a manifestation of cardiac involvement in patients with systemic lupus erythematosus.

Adolescent↗
PubMed1987

[Isolated tricuspid valve prolapse: identification using 2-dimensional and Doppler echocardiography].

Echocardiography has been already applied in previous studies to identify tricuspid valve prolapse. However this anomaly has been found more frequently to be associated with mitral valve prolapse or with other cardiac and lung diseases. Isolated primitive tricuspid prolapse appears in fact a relatively unknown anatomo-clinical entity. In this paper we describe the two-dimensional and Doppler findings of three patients with isolated tricuspid prolapse. Two-dimensional echocardiography is the appropriate technique for its detection and allows the assessment of the echogenic characteristics of the valve texture.

Adult↗
PubMed1986

[Diagnosis of mitral valve prolapse by X-ray CT and MRI].

To evaluate the usefulness of enhanced X-ray CT and gating magnetic resonance imaging (MRI) for diagnosing mitral valve prolapse, three patients with this abnormality and several controls were examined by these two methods. The mitral valve was not recognized by X-ray CT except a few cases with thickened mitral valve. However, MRI could demonstrate clearly the mitral leaflets and annulus in many subjects. In transverse MR imaging of the subjects without valvular disease, the closed mitral valve showed V-shaped appearance in the left ventricle during systole. In a patient with marked mitral valve prolapse, MRI revealed buckling of the posterior mitral leaflet into the left atrium, and in two other patients with mild mitral valve prolapse, MRI demonstrated displacement of coaptation of the anterior leaflet toward the left atrium. These results suggest MRI is a useful method for diagnosing mitral valve prolapse.

Echocardiography↗
PubMed1986

[Association of anorexia nervosa and mitral valve prolapse].

Four cases of anorexia nervosa recently encountered were reported in respect to their cardiovascular manifestations including prolapse of the cardiac valves and other poorly recognized cardiac findings. All four patients, aged 13 to 32 years, were women and had marked emaciation (35 to 44% weight loss of the ideal body weight) with typical hormone abnormalities. Chest radiographs showed a small cardiac shadow, and sinus bradycardia with low voltage was present in their electrocardiograms. One case, 13-year-old, had a mid-systolic click and occasionally a late systolic murmur, and also an abdominal continuous hum. Echocardiography including two-dimensional color flow-mapping disclosed mitral valve prolapse in all, and tricuspid valve prolapse in two. Mild to moderate pericardial effusion was noted in all between the right ventricle and diaphragm, and pericardiocentesis in one case had no effect on the valve movements. No inflammatory changes were observed in the specimen of the pericardium and also of the fluid. An association of mitral valve prolapse and anerexia nervosa was discussed based on the previous studies, but the final conclusion remains unknown.

Adolescent↗
PubMedDate not supplied

[Urologic consequences of severe genital prolapse].

From three observations, the authors analyse the ureteric dilatation and genital prolapse association from an anatomo-clinic point of view. The bladder-base displacement situated in the vaginal prolapse and the resulting very sharp angle formed by the terminal ureter portion are enough to explain the pathogenesis of the observed urinary lesions. The repercussions of advanced prolapses upon upper urinary tracts are rarely mentioned in literature. The three reported clinic cases are absolutely demonstrative: for every one, the major uretero pyelectasis is associated with a progressive renal insufficiency. Authors insist upon urologic symptoms quick regression after a prolapse cure. This correction is made either by putting a pessary, either by a surgical cure unless the risk should be too important for the patient.

Aged↗
PubMed1986

Esophageal disorders in patients with chest pain and mitral valve prolapse.

The origin of chest discomfort in patients with mitral valve prolapse is controversial. We performed esophageal manometry in 18 patients with mitral valve prolapse, chest pain, and no significant coronary artery disease at cardiac catheterization. Fourteen of the 18 had esophageal disorders: five had diffuse esophageal spasm and two had hypertensive lower esophageal sphincter-motility disorders associated with chest pain syndromes; five mitral valve prolapse patients had hypotensive lower esophageal sphincters, a finding that increases the probability of symptomatic gastroesophageal reflux; and two had nonspecific motor abnormalities. Esophageal disorders may provide an explanation for chest discomfort experienced by certain patients with mitral valve prolapse.

Adult↗
PubMed1985

Rectal prolapse.

Rectal prolapse occurs mostly in the geriatric female patient and can be a very disabling condition. The etiology is intussusception of the rectosigmoid secondary to excessive and prolonged straining. Medical therapy for this disease process is not helpful and patients will require a surgical procedure. The two best surgical procedures for the correction of rectal prolapse are low anterior resection of the rectosigmoid and proctopexy. A few patients who are unfit for laparotomy may require the Thiersch Wire procedure. Two unresolved problems after surgical therapy are continuing constipation and incontinence. Constipation is treated by dietary measures, stool softeners, and periodic enemas. Laxatives are to be discouraged. Incontinence in patients with rectal prolapse improves in most patients after a procedure to correct the prolapse. In those patients in which incontinence persists, no form of therapy has been found to be uniformly successful.

Adult↗
PubMed1985

Rectal prolapse and cystic calculus in a burro.

A 7-year-old burro jack was examined because of recurrent rectal prolapse and severe cough. The prolapse was reduced manually and a cough associated with bronchopneumonia responded to antimicrobial therapy. The rectal prolapse recurred and again was reduced manually. During exploratory celiotomy a cystic calculus was identified and removed. Severe protracted cough and cystic calculus were thought to be contributing factors to recurrent rectal prolapse in this burro.

Animals↗
PubMed1985

Rectal prolapse in scleroderma: case report and review of the colonic complications of scleroderma.

Scleroderma of the colon is commonly associated with constipation, as was the case in a 70-year-old woman with rectal prolapse described by the authors. The chronic constipation in this patient may have been the cause of her rectal prolapse, but the onset of the prolapse and scleroderma at about the same time suggest that the scleroderma may have been a causative factor. A Ripstein repair of the prolapse was carried out. The authors discuss some of the complications of colonic scleroderma, which include megacolon, transverse and sigmoid colonic volvulus, telangiectasia, stenosis and diverticula and stercoral ulceration.

Aged↗
PubMed1985

Association of mitral valve leaflet prolapse with cerebral ischaemic events in the young and early middle-aged patient.

In order to clarify possible links between mitral valve leaflet prolapse and cerebral ischaemic events we carried out a study prospectively over a period of two years on 66 patients (35 men and 31 women) under the age of 50 who suffered from transient cerebral ischaemic attacks or completed strokes. Twenty-three (34.8 per cent) of the 66 patients were found to have mitral valve leaflet prolapse syndrome. In 16 (24.2 per cent) of those, the only abnormality found was mitral valve leaflet prolapse, suggesting that the mitral valve leaflet prolapse syndrome may be a potential cause of cerebral ischaemic events. Therapeutic approaches for preventing further similar events are discussed.

Adult↗
PubMed1985

[Anal prolapse in the child].

Two different conditions are contrasted: mucosal prolapse in children aged between 2 and 5 years and total prolapse, which is very rare. Mucosal prolapse has become very rare in industrialised countries because of the excellent improvement in nutrition since the war, while this remains a very serious condition in under-developed countries. It is rapidly cured, provided the therapeutic errors are avoided, in particular cerclage. Sclerosis with quinine-urea is indicated in this situation. The various causes are discussed: in particular, the abnormal fixation of the rectum and the absence of the sacral curvature. The predisposing factors are essentially prolonged time spent on the pot, constipation and prolonged diarrhoea and, most importantly, malnutrition and prematurity. Total prolapse in very rare; it is about 15 centimetres long curved posteriorly and often incoercible. It occurs in younger infants and even neonates. It is often irreducible and therefore requires surgery in certain cases. It frequently disappears after the age of 8 years. There are a number of very different causes, not only malnutrition and prematurity and, in this clinical context, strain plays an important role and may be due to a vesical or urethral stone or to a congenital abnormality of these organs, but also abnormalities of the rectal segment with disorders of innervation, connective tissue diseases, any diseases affecting the internal sphincter, in particular congenital abnormalities. Abnormalities of the intrinsic rectal innervation with loss of sensitivity are frequent and can be due to denervations caused by a surgical operation (Hirschsprung's operation, for example). Abnormalities of the baso-receptors have also been observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed1979

Mitral valve prolapse syndrome in children with Duchenne's progressive muscular dystrophy.

Myocardial function was evaluated prospectively by noninvasive methods in 20 boys with clinical, biochemical, muscle biopsy, and electromyographic evidence of Duchenne's progressive muscular dystrophy. Auscultatory evidence of a nonejection systolic click suggested mitral valve prolapse (MVP) syndrome in seven patients. Phonocardiography disclosed that the click was mid-systolic in four patients and early in three. Echocardiographic features consistent with this diagnosis were identified in all seven patients and in an additional four. One of these had an apical pansystolic murmur, suggestive of mitral regurgitation, whereas in the other three, prolapse of the mitral valve was "silent". Echocardiographic findings included an abrupt midsystolic, posterior motion (greater than 3 mm beyond the CD line) in five patients, multiple sequence echoes in six, and posterior coaptation of the mitral valve near the left atrial wall in six. The features most characteristic of MVP syndrome was a smooth, pansystolic, anteriorly concave (hammock-like) posterior motion deviating more than 3 mm beyond the CD line. Among the remaining nine patients who did not have echocardiographic evidence of prolapsing mitral valve, none had an early, middle or late nonejection systolic click or a heart murmur, although four patients in this group had moderate to severe scoliosis. These observations document of occurrence of MVP syndrome in children with Duchenne's muscular dystrophy and indicate that its prevalence is high. We speculate that prolapse of the mitral valve in these patients is an expression of the underlying cardiomyopathy characteristic of Duchenne's muscular dystrophy rather than an isolated, dystrophic involvement of the mitral valve leaflets.

Adolescent↗
PubMed1979

[Echocardiographic evaluation of left ventricular function in mitral valve prolapse].

Echocardiographic assessment of left ventricle functions was performed in 52 cases with idiopathic prolapse of mitral valve, confirmed on the base of the simultaneous presence of the well known auscultatory, phonocardiographic and echocardiographic criteria. Mitral prolapse was established not to be a homogenous group as regards left ventricle function. The majority of the cases (80.7%) had normal EchoC-indices for the pump and total and local contraction function of left ventricle. The cases without (25%) or with light stage (55.7%) mitral regurgitation are included here. In the presence of hemodynamic significant mitral insufficiency -- 13.5% of the cases. EchoC-manifestations for volume left-ventricle loading were found -- enlarged telediastolic dimension and volume of the left ventricle cavity, light hypertrophy and hypercontractility of the interventricular septum and/or the unattached posterior wall of left ventricle, enlarged left ventricle, increased velocity of EF-segment of the anterior mitral cusp. As a rule, a moderate mitral regurgitation is concerned in those cases. In a small number of cases with mitral prolapse (5.8%) EchoC-manifestations for a light to moderate pump and general and/or local contraction function of left ventricle was established without clinical data for a stasis in left ventricle cardiac insufficiency. Grounds exist to admit that in the last cases, a rather not severe local or more diffuse lesion of the left ventricle myocardium is concerned, its relationship with the mitral valve prolapse remaining obscure.

Adult↗
PubMed1983

[Idiopathic mitral valve prolapse].

Current knowledge concerning idiopathic prolapse of the mitral valve is illustrated. The histopathological cause is myxoid degeneration of the mitral cusps, which sometimes extends to the tendinous cords, the valve implant ring, and the apex of the papillary muscles. Primary damage to these structures, whose intactness is essential for correct closure of the ostium, causes protrusion of the ventricular cusps into the left atrium during ventricular systole (i.e. prolapse). The reason for this degeneration is not known. The high familial incidence of prolapse lends credit to the most widely held suggestion, namely a hereditary defect. The clinical progress is benign in the great majority of cases ("crystallized" form) and is often asymptomatic. Complications are possible, however, and must always be borne in mind. They include progressive and acute mitral insufficiency, infective endocarditis, arrhythmias, motor or sensitive neurological complications, and sudden death. Particular attention must be paid to the path to be followed to arrive at the correct diagnosis. Careful evaluation of some of the clinical signs arousing suspicion in the previous history and/or objective examination enable a diagnosis to be formed with relatively simple, non-invasive instrumental techniques, such as echocardiography and polycardiography, provided other forms of prolapse secondary to ischaemic heart disease, mitral endocarditis, etc. are excluded. "Therapy is obviously necessary in the presence of complications; however, even in "crystallized" form, in the presence of subjective symptoms, tranquillizers and possibly beta-blockers may be necessary".

Adrenergic beta-Antagonists↗
PubMed1983

[Complications of idiopathic mitral valve prolapse. Prevention and treatment].

Mitral valve prolapse is the most common form of heart disease, as it occurs in 4 to 6 per cent of the population. It has a benign course in the majority of cases, but 5 types of severe complication can occur in 15 per cent of cases. Mitral incompetence occurs in 14.8 per cent of cases. It may develop gradually or suddenly, following rupture of the chordae, which requires rapid surgical repair. Mitral valve prolapse is complicated by infectious endocarditis in 2.9 per cent of cases, hence the need for antibiotic prophylaxis prior to dental treatment or surgery in patients with a pan-systolic or end-systolic murmur. The only arrhythmias which should be considered as complications and treated as such are frequent ventricular extrasystoles of more than 30 per hour, usually associated with bigeminy, runs or polymorphism, ventricular tachycardia and ventricular fibrillation. Treatment consists, primarily, of beta-blockers. Sudden death is of course the major complication, occurring in 1.4 to 2.4 per cent of cases. The patients at risk of this complication are middle-aged women (40 years) with a past history of syncope or faintness due, in most cases, to episodes of ventricular tachycardia or ventricular fibrillation. Apart from arrhythmia, coronary artery spasm has also been found to be a cause of sudden death in these patients. Transient or definitive ocular and cerebral ischaemic episodes can also complicate mitral valve prolapse. Mitral valve prolapse is found in 20 to 30 per cent of patients with neurological accidents before the age of 45. Preventative treatment consists of anti-platelet aggregation agents and anticoagulants in recurrent cases.

Adrenergic beta-Antagonists↗
PubMed1984

Uterine prolapse and hypocalcemia in dairy cows.

Blood samples were collected from 53 dairy cows with uterine prolapse and from 53 cows with normal parturition (no uterine prolapse) matched by dairy as controls for various management programs among dairies. Cows with uterine prolapse had significantly lower total serum calcium content than did controls (P less than 0.01). Mean (+/- SEM) serum calcium content (mg/dl) for affected cows and controls were 6.08 (+/- 0.25) and 6.96 (+/- 0.20), respectively. Severe hypocalcemia (less than 4 mg/dl) was found in 10 (19%) of the affected cows, compared with 1 (1.8%) of the controls. Fifteen (28%) of the affected cows had moderate hypocalcemia (4.1 to 6.0 mg/dl), compared with 14 (26%) of the controls; 19 (36%) of the affected cows were mildly hypocalcemic (6.1 to 7.9 mg/dl), compared with 25 (47%) of the controls. Nine (17%) of the affected cows and 13 (25%) of the controls were within the normal range of calcium content (greater than 8 mg/dl). Nine of the affected cows were first-calf cows. The serum of these animals did not have significantly lower calcium concentrations, compared with controls matched by parity. Serum calcium values (mg/dl) for 9 first-calf cows and the 9 matched controls were 7.24 (+/- 0.42) and 7.00 (+/- 0.39), respectively. It was concluded that hypocalcemia was associated with uterine prolapse in multiparous dairy cows and, along with other factors, is involved as an etiologic factor for this puerperal condition.

Animals↗