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Journal of the Royal Society of Medicine Dec 1992
Topics: Humans; Keratoconus; Mitral Valve Prolapse
PubMed: 1308132
DOI: No ID Found -
Medicina (Kaunas, Lithuania) 2005This article analyzes data obtained from the medical records of the patients with primary mitral valve prolapse. The study population was the patients admitted to Kaunas... (Comparative Study)
Comparative Study
This article analyzes data obtained from the medical records of the patients with primary mitral valve prolapse. The study population was the patients admitted to Kaunas University of Medicine Heart Center (KUMHC) between 1999 and 2003. The objective of our study was to analyze the natural course of mitral valve prolapse, complications and their frequency, treatment strategy in KUMHC, as well as to review the results of surgical treatment. We gathered data from the medical records of 160 patients and analyzed their age, medical history, complications, comorbidities, functional status and echocardiographic parameters. Patients who underwent mitral valve surgery were followed 7.9+/-8.4 months after procedure. On average, 32+/-14 patients with primary mitral valve prolapse were treated at KUMHC annually. Their mean age was 48.4+/-16.5 years, 44.4% of them were male. The most frequent complications of mitral valve prolapse were > or =II degrees mitral regurgitation (78.4%), various cardiac arrhythmias (68.1%) and heart failure of > or =II NYHA class (79%). Surgical treatment was recommended for 64 (40%) KUMHC patients with primary mitral valve prolapse. Surgical treatment was applied in 44 (28.1%) of study patients. The patients, who were recommended surgical treatment, were older (mean age 53.2+/-11.9 years, p<0.05) and predominantly male (62.5%, p<0.05) as compared to medically managed patients. The heart failure (62.5% had NYHA class III or IV), severe mitral regurgitation (95.3% had mitral regurgitation of > or =III degrees ) and worse left ventricle function (15% had ejection fraction of <50%) were more frequent in this group as compared to medically managed patients (all p<0.05). During the last five years the number of hospitalized patients with primary mitral valve prolapse increased 3.2 times, the number of mitral valve surgical procedures among these patients increased 2.8 times, and the number of mitral valve repair increased 15.8 times. 56.8% of patients had uncomplicated postoperative course. The most frequent postoperative complication was new arrhythmias and/or conduction disturbances. 1 patient died in early postoperative period. There was significant decrease in left ventricle and left atrium size and the severity of mitral regurgitation 2 to 6 months after mitral valve surgery. These positive changes remained during all study period. Taking in the consideration the large number of mitral valve repair procedures and good outcomes, the low postoperative mortality of the surgical mitral valve prolapse treatment in KUMHC, we can strongly recommend surgical treatment for the patients with severe mitral regurgitation secondary to mitral valve prolapse.
Topics: Adult; Age Factors; Data Interpretation, Statistical; Echocardiography; Female; Follow-Up Studies; Hospitalization; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Prolapse; Postoperative Complications; Stroke Volume; Time Factors; Treatment Outcome; Ventricular Function, Left
PubMed: 15864006
DOI: No ID Found -
Indian Heart Journal 2021Left atrial (LA) and left ventricular (LV) remodelling are the adaptive changes that occur in primary mitral regurgitation (MR) and are related to its clinical outcomes....
OBJECTIVE
Left atrial (LA) and left ventricular (LV) remodelling are the adaptive changes that occur in primary mitral regurgitation (MR) and are related to its clinical outcomes. Despite the pathophysiological differences in MR in rheumatic heart disease (RHD) and mitral valve prolapse (MVP), whether the pattern of LV and LA remodelling is different between the two conditions remains unknown. Hence, we compared the LA and LV strain pattern in MR due to RHD, the predominant etiology in developing countries topatients with MVP and age and sex-matched controls.
METHODS
A total of 50 patients of severe MR which included 30 MVP MR and 20 RHD MR were assessed by strain imaging by speckle tracking echocardiography (STE) and were compared with age and sex-matched controls. 2D STE was used for LA and 3D STE was used for LV strain analysis. LA and LV strain parameters were compared between MVP MR and RHD MR groups.
RESULTS
30 patients with MVP and 20 with RHD were studied. 60% (n = 30) were symptomatic. Mean GLS was -17.2 ± 4.4% compared to -20 ± 3.2% among controls and mean LA strain was 17.35 ± 10.3% compared to 51.34 ± 11.5% among controls which were significantly lower (both p < 0.01). No significant difference in LA strain and GLS was found between MVP and RHD subgroups (LA strain 20.45 ± 11.9% and 14.63 ± 8.85%; p = 0.08; GLS - 18.25 ± 4.3% and-16.2 ± 4.6%; p = 0.12). PALS in the RHD group was lower compared to MVP(p = 0.08) which showed a trend towards significance. LV strain parameters showed no significant difference among the MVP and RHD groups.
CONCLUSION
LA and LV strain parameters showed no significant difference in MR due to either RHD or MVP. There was a trend towards lower LA strain in RHD which needs validation with large multicentric studies. The current strain parameters from MVP with the prognostic value may be applied to MR of RHD etiology, pending confirmation of our results by other groups.
Topics: Adolescent; Adult; Aged; Echocardiography, Doppler; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Prolapse; Myocardial Contraction; Retrospective Studies; Rheumatic Heart Disease; Ventricular Remodeling; Young Adult
PubMed: 33714415
DOI: 10.1016/j.ihj.2020.11.010 -
Europace : European Pacing,... Feb 2023
Topics: Humans; Mitral Valve Prolapse; Latin America; Mitral Valve; Heart Valve Diseases; Risk Assessment
PubMed: 36413621
DOI: 10.1093/europace/euac209 -
European Journal of Cardio-thoracic... Oct 2023Uncorrected severe mitral regurgitation (MR) due to posterior prolapse leads to left ventricular dilatation. At this stage, mitral valve repair becomes mandatory to...
Neochordae implantation versus leaflet resection in mitral valve posterior leaflet prolapse and dilated left ventricle: a propensity score matching comparison with long-term follow-up.
OBJECTIVES
Uncorrected severe mitral regurgitation (MR) due to posterior prolapse leads to left ventricular dilatation. At this stage, mitral valve repair becomes mandatory to avoid permanent myocardial injury. However, which technique among neochoardae implantation and leaflet resection provides the best results in this scenario remains unknown.
METHODS
We selected 332 patients with left ventricular dilatation and severe degenerative MR due to posterior leaflet (PL) prolapse who underwent neochoardae implantation (85 patients) or PL resection (247 patients) at our institution between 2008 and 2020. A propensity score matching analysis was carried on to decrease the differences at baseline.
RESULTS
Matching yielded 85 neochordae implantations and 85 PL resections. At 10 years, freedom from cardiac death and freedom from mitral valve reoperation were 92.6 ± 6.1% vs 97.8 ± 2.1% and 97.7 ± 2.2% vs 95 ± 3% in the neochordae group and in the PL resection group, respectively. The MR ≥2+ recurrence rate was 23.9 ± 10% in the neochordae group and 20.8 ± 5.8% in the PL resection group (P = 0.834) at 10 years. At the last follow-up, the neochordae group showed a higher reduction of left ventricular end-diastolic diameter (44 vs 48 mm; P = 0.001) and a better ejection fraction (60% vs 55%; P < 0.001) compared to PL resection group.
CONCLUSIONS
In this subgroup of patients, both neochordae implantation and leaflet resection provide excellent durability of the repair in the long term. Neochordae implantation might have a better effect on dilated left ventricle.
Topics: Humans; Mitral Valve; Mitral Valve Insufficiency; Follow-Up Studies; Heart Ventricles; Propensity Score; Treatment Outcome; Chordae Tendineae; Mitral Valve Prolapse; Prolapse; Heart Valve Prosthesis Implantation
PubMed: 37551944
DOI: 10.1093/ejcts/ezad274 -
The International Journal of... Feb 2010
Topics: Biomarkers; Echocardiography, Doppler; Electrocardiography, Ambulatory; Heart Rate; Humans; Inflammation Mediators; Magnetic Resonance Imaging; Mitral Valve Insufficiency; Mitral Valve Prolapse; Risk Assessment; Risk Factors; Severity of Illness Index; Tachycardia, Ventricular; Ventricular Premature Complexes
PubMed: 20175294
DOI: 10.1007/s10554-009-9540-4 -
EuroIntervention : Journal of EuroPCR... Sep 2017The treatment of mitral regurgitation has changed in recent years due to the advent of interventional techniques, mostly the percutaneous edge-to-edge repair, and, more...
The treatment of mitral regurgitation has changed in recent years due to the advent of interventional techniques, mostly the percutaneous edge-to-edge repair, and, more recently, annuloplasty and chordal replacement. In the future, more advances are expected from further development of interventional techniques, careful evaluation and better patient selection.
Topics: Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Mitral Valve Prolapse; Plastic Surgery Procedures; Reoperation; Surgical Instruments; Suture Techniques; Treatment Outcome
PubMed: 28942383
DOI: 10.4244/EIJ-D-17-00505 -
The New England Journal of Medicine Jul 1999Mitral-valve prolapse has been described as a common disease with frequent complications. To determine the prevalence of mitral-valve prolapse in the general population,...
BACKGROUND
Mitral-valve prolapse has been described as a common disease with frequent complications. To determine the prevalence of mitral-valve prolapse in the general population, as diagnosed with the use of current two-dimensional echocardiographic criteria, we examined the echocardiograms of 1845 women and 1646 men (mean [+/-SD] age, 54.7+/-10.0 years) who participated in the fifth examination of the offspring cohort of the Framingham Heart Study.
METHODS
Classic mitral-valve prolapse was defined as superior displacement of the mitral leaflets of more than 2 mm during systole and as a maximal leaflet thickness of at least 5 mm during diastasis, and nonclassic prolapse was defined as displacement of more than 2 mm, with a maximal thickness of less than 5 mm.
RESULTS
A total of 84 subjects (2.4 percent) had mitral-valve prolapse: 47 (1.3 percent) had classic prolapse, and 37 (1.1 percent) had nonclassic prolapse. Their age and sex distributions were similar to those of the subjects without prolapse. None of the subjects with prolapse had a history of heart failure, one (1.2 percent) had atrial fibrillation, one (1.2 percent) had cerebrovascular disease, and three (3.6 percent) had syncope, as compared with unadjusted prevalences of these findings in the subjects without prolapse of 0.7, 1.7, 1.5, and 3.0 percent, respectively. The frequencies of chest pain, dyspnea, and electrocardiographic abnormalities were similar among subjects with prolapse and those without prolapse. The subjects with prolapse were leaner (P<0.001) and had a greater degree of mitral regurgitation than those without prolapse, but on average the regurgitation was classified as trace or mild.
CONCLUSIONS
In a community based sample of the population, the prevalence of mitral-valve prolapse was lower than previously reported. The prevalence of adverse sequelae commonly associated with mitral-valve prolapse in studies of patients referred for that diagnosis was also low.
Topics: Adult; Age Distribution; Aged; Comorbidity; Echocardiography; Female; Heart Diseases; Humans; Male; Massachusetts; Middle Aged; Mitral Valve; Mitral Valve Prolapse; Prevalence; Prospective Studies; Sex Distribution
PubMed: 10387935
DOI: 10.1056/NEJM199907013410101 -
Journal of Cardiothoracic Surgery Jun 2019At present, multi-detector cardiac CT has been widely applied in the detection of heart valve morphology and function. This study aims to compare the coronary CT...
OBJECTIVE
At present, multi-detector cardiac CT has been widely applied in the detection of heart valve morphology and function. This study aims to compare the coronary CT angiography and trans-thoracic echocardiography for patients with mitral valve prolapse.
METHODS
CT angiography and trans-thoracic echocardiography were adopted to detect the movement range and thickness of valvula bicuspidalis. The ultrasonic parameters of CT angiography were considered as standard reference value.
RESULTS
Receiver operating characteristic (ROC) curve showed that the area of mitral valve motion amplitude under ROC curve was 95% detected by CT angiography with statistical significance (P < 0.001). Based on the intercept point on the ROC curve, the sensitivity and accuracy of mitral valve amplitude detected by CT angiography was 69.2 and 95.6%, the false positive and false negative rate was 5.2 and 32.4%, the predicted value of positive and negative was 92.9 and 76.9% and the consistency rate of motion range and leaf thickness detected by CT angiography was 83.3 and 47.5%. Trans-thoracic echocardiography showed that the thickness and motion range of mitral leaflet was (1.95 ± 0.22) mm and (1.5 ± 2.28) mm. The thickness and motion range of mitral leaflet that detected by CT was (2.00 ± 0.54) mm and (3.76 ± 2.1) mm.
CONCLUSION
The accuracy and reliability of CT angiography for patients with mitral valve prolapse are higher than those of trans-thoracic echocardiography.
Topics: Aged; Computed Tomography Angiography; Coronary Angiography; Echocardiography; False Negative Reactions; False Positive Reactions; Female; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Prolapse; Reproducibility of Results; Sensitivity and Specificity
PubMed: 31234872
DOI: 10.1186/s13019-019-0925-8 -
Heart (British Cardiac Society) Feb 2017We aimed to investigate the association of diffuse myocardial fibrosis by cardiac magnetic resonance (CMR) T with complex ventricular arrhythmia (ComVA) in mitral valve...
OBJECTIVE
We aimed to investigate the association of diffuse myocardial fibrosis by cardiac magnetic resonance (CMR) T with complex ventricular arrhythmia (ComVA) in mitral valve prolapse (MVP).
METHODS
A retrospective analysis was performed on 41 consecutive patients with MVP referred for CMR between 2006 and 2011, and 31 healthy controls. Arrhythmia analysis was available in 23 patients with MVP with Holter/event monitors. Left ventricular (LV) septal T times were derived from Look-Locker sequences after administration of 0.2 mmol/kg gadopentetate dimeglumine. Late gadolinium enhancement (LGE) CMR images were available for all subjects.
RESULTS
Patients with MVP had significantly shorter postcontrast T times when compared with controls (334±52 vs 363±58 ms; p=0.03) despite similar LV ejection fraction (LVEF) (63±7 vs 60±6%, p=0.10). In a multivariable analysis, LV end-diastolic volume, LVEF and mitral regurgitation fraction were all correlates of T times, with LVEF and LV end-diastolic volume being the strongest (p=0.005, p=0.008 and p=0.045, respectively; model adjusted R=0.30). Patients with MVP with ComVA had significantly shorter postcontrast T times when compared with patients with MVP without ComVA (324 (296, 348) vs 354 (327, 376) ms; p=0.03) and only 5/14 (36%) had evidence of papillary muscle LGE.
CONCLUSIONS
MVP may be associated with diffuse LV myocardial fibrosis as suggested by reduced postcontrast T times. Diffuse interstitial derangement is linked to subclinical systolic dysfunction, and may contribute to ComVA in MVP-related mitral regurgitation, even in the absence of focal fibrosis.
Topics: Adult; Arrhythmias, Cardiac; Boston; Cardiomyopathies; Contrast Media; Databases, Factual; Female; Fibrosis; Humans; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Mitral Valve Prolapse; Myocardium; Predictive Value of Tests; Retrospective Studies; Stroke Volume; Ventricular Function, Left
PubMed: 27515954
DOI: 10.1136/heartjnl-2016-309303