Identification of High-Risk and Low-Risk Subgroups of Patients with Mitral-Valve Prolapse

1989 ◽  
Vol 320 (16) ◽  
pp. 1031-1036 ◽  
Author(s):  
Andrew R. Marks ◽  
Christopher Y. Choong ◽  
Anthony J. Sanfilippo ◽  
Merry Ferré ◽  
Arthur E. Weyman
Keyword(s):  
High Risk ◽  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Low Risk

scholarly journals Interscallop separations of the posterior mitral valve leaflet: a solution to the ‘borderline RHD’ conundrum?

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001452
Author(s):  
Luke David Hunter ◽  
Mark Monaghan ◽  
Guy Lloyd ◽  
Carl Lombard ◽  
Alfonso Jan Kemp Pecoraro ◽  
...  
Keyword(s):  
High Risk ◽  
Mitral Valve ◽  
South African ◽  
Underlying Mechanism ◽  
Low Risk ◽  
Cross Sectional ◽  
Mitral Valve Leaflet ◽  
Echocardiographic Study ◽  
Sole Criterion ◽  
High Risk Children

ObjectiveThe World Heart Federation (WHF) criteria incorporate a Doppler-based system to differentiate between ‘physiological’ and ‘pathological’ mitral regurgitation (MR)—a sole criterion sufficient for the diagnosis of WHF ‘borderline’ rheumatic heart disease (RHD). We have identified that interscallop separations (ISS) of the posterior mitral valve (MV) leaflet, can give rise to pathological MR in an otherwise-normal MV. We aimed to establish and compare the prevalence of ISS-related MR among South African children at high and low risk for RHD.MethodsA prospective cross-sectional echocardiographic study of 759 school children (aged 13–18) was performed. Cases with MR≥1.5 cm underwent a second comprehensive study to determine the prevalence of RHD according to the WHF guideline and establish the underlying mechanism of MR.ResultsOf 400 high-risk children, two met criteria for ‘definite RHD’ (5 per 1000 (95% CI 1.4 to 18.0); p=0.5) and 11 for ‘borderline RHD’ (27.5 per 1000 (95% CI 15.4 to 48.6)). Of 359 low-risk children, 14 met criteria for borderline RHD (39 per 1000 (95% CI 23.4 to 64.4)). Comprehensive echocardiography identified an underlying ISS as the mechanism of isolated pathological MR in 10 (83.3%) high-risk children and 11 low-risk children (78.5%; p>0.99).ConclusionsISS are a ubiquitous finding among South African schoolchildren from all risk profiles and are regularly identified as the underlying mechanism of WHF pathological MR in borderline RHD cases. A detailed MV assessment with an emphasis on ascertaining the underlying mechanism of dysfunction could reduce the reported numbers of screened cases misclassified as borderline RHD.

scholarly journals Pickelhaube Spike, a High-Risk Marker for Bileaflet Myxomatous Mitral Valve Prolapse: Sonographer's Quest for the Highest Spike

2020 ◽  
Vol 33 (5) ◽  
pp. 639-640
Author(s):  
Denise Ignatowski ◽  
McKenzie Schweitzer ◽  
Kelly Pesek ◽  
Renuka Jain ◽  
Lakshmi Muthukumar ◽  
...  
Keyword(s):  
High Risk ◽  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Risk Marker

Identification of a high-risk subgroup with malignant mitral valve prolapse who are predisposed to sudden cardiac death. A Review

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ronald Russo ◽  
Abhishek Maan ◽  
Eirini Apostolidou ◽  
Arshia Khorasani-zadeh ◽  
Sean Byrnes ◽  
...  
Keyword(s):  
High Risk ◽  
Sudden Cardiac Death ◽  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Cardiac Death

scholarly journals Frailty and related outcomes in patients undergoing transcatheter valve therapies in a nationwide cohort

2019 ◽  
Vol 40 (27) ◽  
pp. 2231-2239 ◽  
Author(s):  
Harun Kundi ◽  
Jeffrey J Popma ◽  
Matthew R Reynolds ◽  
Jordan B Strom ◽  
Duane S Pinto ◽  
...  
Keyword(s):  
High Risk ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Risk Score ◽  
Low Risk ◽  
Intermediate Risk ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
Risk Patients ◽  
Transcatheter Valve

Abstract Aims We sought to identify the prevalence and related outcomes of frail individuals undergoing transcatheter mitral valve repair and transcatheter aortic valve replacement (TAVR). Methods and results Patients aged 65 and older were included in the study if they had at least one procedural code for transcatheter mitral valve repair or TAVR between 1 January 2016 and 31 December 2016 in the Centers for Medicare and Medicaid Services Medicare Provider and Review database. The Hospital Frailty Risk Score, an International Classification of Diseases, Tenth Revision (ICD-10) claims-based score, was used to identify frailty and the primary outcome was all-cause 1-year mortality. A total of 3746 (11.6%) patients underwent transcatheter mitral valve repair and 28 531 (88.4%) underwent TAVR. In the transcatheter mitral valve repair and TAVR populations, respectively, there were 1903 (50.8%) and 14 938 (52.4%) patients defined as low risk for frailty (score <5), 1476 (39.4%) and 11 268 (39.5%) defined as intermediate risk (score 5–15), and 367 (9.8%) and 2325 (8.1%) defined as high risk (score >15). One-year mortality was 12.8% in low-risk patients, 29.7% in intermediate-risk patients, and 40.9% in high-risk patients undergoing transcatheter mitral valve repair (log rank P < 0.001). In patients undergoing TAVR, 1-year mortality rates were 7.6% in low-risk patients, 17.6% in intermediate-risk patients, and 30.1% in high-risk patients (log rank P < 0.001). Conclusions This study successfully identified individuals at greater risk of short- and long-term mortality after undergoing transcatheter valve therapies in an elderly population in the USA using the ICD-10 claims-based Hospital Frailty Risk Score.

Papillary Thyroid Carcinoma: How Radical Lymphadenectomy Should be Performed?

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 63-68
Author(s):  
Schweizer ◽  
Seifert ◽  
Gemsenjäger
Keyword(s):  
High Risk ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Low Risk ◽  
Papillary Thyroid ◽  
Sentinel Nodes ◽  
Fand Sich ◽  
Radical Lymphadenectomy ◽  
N Status

Fragestellung: Die Bedeutung von Lymphknotenbefall bei papillärem Schilddrüsenkarzinom und die optimale Lymphknotenchirurgie werden kontrovers beurteilt. Methodik: Retrospektive Langzeitstudie eines Operateurs (n = 159), prospektive Dokumentation, Nachkontrolle 1-27 (x = 8) Jahre, Untersuchung mit Bezug auf Lymphknotenbefall. Resultate: Staging. Bei 42 Patienten wurde wegen makroskopischem Lymphknotenbefall (cN1) eine therapeutische Lymphadenektomie durchgeführt, mit pN1 Status bei 41 (98%) Patienten. Unter 117 Patienten ohne Anhalt für Lymphknotenbefall (cN0) fand sich okkulter Befall bei 5/29 (17%) Patienten mit elektiver (prophylaktischer) Lymphadenektomie, und bei 2/88 (2.3%) Patienten ohne Lymphadenektomie (metachroner Befall) (p < 0.005). Lymphknotenrezidive traten (1-5 Jahre nach kurativer Primärtherapie) bei 5/42 (12%) pN1 und bei 3/114 (2.6%) cN0, pN0 Tumoren auf (p = 0009). Das 20-Jahres-Überleben war bei TNM I + II (low risk) Patienten 100%, d.h. unabhängig vom N Status; pN1 vs. pN0, cN0 beeinflusste das Überleben ungünstig bei high risk (>= 45-jährige) Patienten (50% vs. 86%; p = 0.03). Diskussion: Der makroskopische intraoperative Lymphknotenbefund (cN) hat Bedeutung: - Befall ist meistens richtig positiv (pN1) und erfordert eine ausreichend radikale, d.h. systematische, kompartiment-orientierte Lymphadenektomie (Mikrodissektion) zur Verhütung von - kurablem oder gefährlichem - Rezidiv. - Okkulter Befall bei unauffälligen Lymphknoten führt selten zum klinischen Rezidiv und beeinflusst das Überleben nicht. Wir empfehlen eine weniger radikale (sampling), nur zentrale prophylaktische Lymphadenektomie, ohne Risiko von chirurgischer Morbidität. Ein empfindlicherer Nachweis von okkultem Befund (Immunhistochemie, Schnellschnitt von sampling Gewebe oder sentinel nodes) erscheint nicht rational. Bei pN0, cN0 Befund kommen Verzicht auf 131I Prophylaxe und eine weniger intensive Nachsorge in Frage.

Individuals at high risk for suicide are categorically distinct from those at low risk.

2017 ◽  
Vol 29 (4) ◽  
pp. 382-393 ◽  
Author(s):  
Tracy K. Witte ◽  
Jill M. Holm-Denoma ◽  
Kelly L. Zuromski ◽  
Jami M. Gauthier ◽  
John Ruscio
Keyword(s):  
High Risk ◽  
Low Risk
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