Features of degenerative mitral valve prolapse in the North East of China: repair characteristics, and short-term follow-up results

2020 ◽  
Vol 68 (5) ◽  
Author(s):  
Silvia Corona ◽  
Paolo Barbier ◽  
Guangyu Liu ◽  
Osafo A. Annoh ◽  
Marcio Scorsin ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Short Term ◽  
North East ◽  
The North

Autoimmune Pancreatitis – Diagnosis, Management and Longterm Follow-up

2014 ◽  
Vol 23 (2) ◽  
pp. 179-185 ◽  
Author(s):  
Suvadip Chatterjee ◽  
Kofi W. Oppong ◽  
John S. Scott ◽  
Dave E. Jones ◽  
Richard M. Charnley ◽  
...  
Keyword(s):  
Autoimmune Pancreatitis ◽  
Rare Condition ◽  
Team Approach ◽  
Diagnostic Challenge ◽  
Multisystem Disorder ◽  
North East ◽  
The North ◽  
Work Up ◽  
Igg4 Level

Background & Aims: Autoimmune pancreatitis (AIP) is a fibroinflammatory condition affecting the pancreas and could present as a multisystem disorder. Diagnosis and management can pose a diagnostic challenge in certain groups of patients. We report our experience of managing this condition in a tertiary pancreaticobiliary centre in the North East of England.Methods: Patients were identified from a prospectively maintained database of patients diagnosed with AIP between 2005 and 2013. Diagnosis of definite/probable AIP was based on the revised HISORt criteria. When indicated, patients were treated with steroids and relapses were treated with azathioprine. All patients have been followed up to date.Results: Twenty-two patients were diagnosed with AIP during this period. All patients had pancreatic protocol CT performed while some patients had either MR or EUS as part of the work up. Fourteen out of 22 (64%) had an elevated IgG4 level (mean: 10.9 g/L; range 3.4 - 31 g/L). Four (18%) patients underwent surgery. Extrapancreatic involvement was seen in 15 (68%) patients, with biliary involvement being the commonest. Nineteen (86%) were treated with steroids and five (23%) required further immunosuppression for treatment of relapses. The mean follow up period was 36.94 months (range 7 - 94).Conclusion: Autoimmune pancreatitis is being increasingly recognized in the British population. Extrapancreatic involvement, particularly extrahepatic biliary involvement seems to be a frequent feature.Diagnosis should be based on accepted criteria as this significantly reduces the chances of overlooking malignancy. Awareness of this relatively rare condition and a multi-disciplinary team approach will help us to diagnose and treat this condition more efiectively thereby reducing unnecessary interventions.

scholarly journals Mitral valve prolapse - it"s possible to stratify prognosis in these patients?

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P Silverio Antonio ◽  
T Rodrigues ◽  
R Santos ◽  
A Nunes-Ferreira ◽  
N Cunha ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Nyha Class ◽  
Univariate Analysis ◽  
Developed Countries ◽  
Maximum Distance ◽  
Conduction Delay ◽  
Systolic Pulmonary Artery Pressure ◽  
Lv Mass

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Mitral valve prolapse (MVP) is one of the most frequent causes of mitral valve disease in developed countries, traditionally with a benign prognosis, however some patients develop arrythmias and significant mitral regurgitation (MR) with need of intervention. Herein our purpose was to establish clinical, electrocardiographic and echocardiographic predictors of arrythmias, mitral valve intervention (MVI) and hospitalization in MVP patients to better characterize the prognosis in these patients. Methods  Single-center retrospective study of consecutive patients with MVP documented in transthoracic echocardiogram between January 2014 and October 2019. MVP was defined as systolic displacement of the mitral leaflet into the left atrium ≥ 2 mm from the mitral annular plane. Demographic, clinical, echocardiographic, electrocardiographic data were collected as well as adverse events at follow-up. The results were obtained using Chi-square and Student-t tests; predictors were found with logistic regression. Results  247 patients were included (mean age 62.9 ± 18 years, 61% males), most with MVP involving the posterior leaflet (48.6%). 40% were symptomatic, 47.4% had more than moderate MR, and 25% had interventricular conduction delay in the ECG. During a mean follow-up of 30 ± 19 months, 38% had arrythmias, 27.1% needed mitral valve intervention (95% surgery and 5% percutaneous), 27.1% had atrial fibrillation (AF), 3.4% had ventricular arrythmias, 19.2% had ventricular premature beats, 13.3% had hospital admission for cardiovascular cause and 8.5% (n = 21) died. 9.3% of the patients had mitral annulus disjunction (MAD). Palpitations (p = 0.018), AF (p < 0.001), significant MR (p < 0.001), higher NYHA class (p = 0.016), systolic pulmonary artery pressure (SPAP) (p < 0.001), LV mass (p < 0.001), QTc (p = 0.01) and MAD maximum distance (p = 0.02) associated with MVI. MAD maximum distance value presented an excellent capacity to predict the MVI (AUC 0.85 p = 0.019); the best cut-off was 11,5 mm (Sens = 80%; Spec = 83%). AF was a predictor of hospitalization in univariate analysis (OR = 2.57, CI95% 1.15-5.75, p = 0.022). Regarding arrhythmic events, we found association with aortic root dilatation (p = 0.032), NYHA III-IV (p = 0.013), age and LV mass (both with p < 0.001). In multivariate analysis, LV mass (OR = 1.02, CI95% 1.005-1.027, p = 0.005) and age (OR = 1.038, CI95% 1.004-1.053, p = 0.021) were independent predictors of arrythmias. In this sample, MAD was not associated with arrythmias. Conclusion  Opposing to previous studies in our population, MAD was not associated with arrythmias but had an excellent capacity to predict MVI. Age and LV hypertrophy were independent predictors of arrythmias in our patients. Larger studies are needed to better stratify patients with MVP, as its association with arrhythmias, hospitalization and the need for intervention is not negligible.

Mitral Valve Prolapse and Athletic Participation in Children and Adolescents

PEDIATRICS ◽  
1995 ◽  
Vol 95 (5) ◽  
pp. 789-790
Author(s):  
Keyword(s):  
Mitral Valve ◽  
Children And Adolescents ◽  
Mitral Valve Prolapse ◽  
Holter Monitoring ◽  
Premature Ventricular Contractions ◽  
Benign Condition ◽  
Migraine Headaches ◽  
Asymptomatic Patients ◽  
Vascular Accidents

Mitral valve prolapse (MVP) is generally a benign condition characterized by the protrusion of the mitral valve leaflets into the left atrium during systole. The prevalence of MVP in individuals under the age of 18 years is estimated to be 5% but is higher in those with Marfan's syndrome and other collagen vascular disorders.1 A midsystolic nonejection click with or without a late systolic murmur is the auscultatory hallmark of this syndrome. The diagnosis of MVP in children and adolescents should be based primarily on auscultatory findings and not on minor echocardiographic findings.1 The prognosis in children and adolescents with isolated MVP appears to be excellent and complications are rare. In 553 children, aged 15 days to 18 years, who were involved in studies with a follow-up period of 6 to 9 years, the following were reported: subacute bacterial endocarditis (one case), cerebral vascular accidents (two cases), migraine headaches (four cases), and chest pain (12 cases).2,3 Only four cases of sudden death have been reported in patients younger than 20 years of age.1-4 In a study of 103 patients with MVP, 16% were found to have premature ventricular beats during exercise electrocardiography (ECG) (exercise test).3 Thirty-eight percent were found to have premature ventricular contractions (PVCs) on 24-hour ECG (Holter) monitoring. This study, however, does not report the true prevalence of dysrhythmias because all these subjects had been referred to a pediatric cardiologist for evaluation. It is likely that these reported numbers are high because asymptomatic patients are less often referred.

scholarly journals P1304 Is antibiotic profilaxis really not needed in mitral valve prolapse?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Suma ◽  
S Coli ◽  
W Serra ◽  
I Spaggiari ◽  
A Botti ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Antibiotic Therapy ◽  
Mitral Valve Prolapse ◽  
Valvular Disease ◽  
Posterior Leaflet ◽  
Class Iii ◽  
Level Of Evidence ◽  
Native Valve ◽  
Dental Procedures

Abstract Patient Presentation A 54 years old woman with dyslipidemia was admitted to the hospital due to the onset of persistent fever. She had no significant comorbidities and she had a known mitral valve prolapse, which was in clinical and echocardiographic follow-up since more than 15 years before. Two months before the hospitalization she underwent dental hygiene procedure without taking any antibiotic before. The procedure included scaling and polishing of the teeth, and she referred just a mild bleeding. After few days she reported the onset of fever and therefore she started to take amoxicilline/clavulanic acid but without any significant improvement of symptoms. Initial work up At the blood chemistry she had a mild leucocytosis with neutrophilia and a rise in inflammatory indices. The Chest x-ray was normal. A systolic murmur was evident at the physical examination. Therefore, Transthoracic Echocardiogram was performed, followed by Transesophageal Echocardiogram (see Figure). At the Echo there was a significant endocarditic involvement of the mitral valve with multiple vegetations, two on the posterior leaflet (scallop P1 and P3) and one on the anterior one (scallop A3); moreover, there was a flail of the posterior leaflet (scallop P1) with subsequent moderate to severe eccentric valve regurgitation. Diagnosis and management Diagnosis of Endocarditis was made and, thus, antibiotic therapy was started with gentamicin and daptomycin, then switched to ampicillin and ceftriaxone after the isolation at the blood culture of Enterococcus Faecalis sensitive to them. Cerebral CT was performed with no evidence of embolization. Finally, owing to the significant endocarditis of the mitral valve with associate moderate to severe regurgitation, the patient underwent surgical intervention with mitral valve replacement with bioprosthesis. Follow-up The post-operative period was regular with no significant complications. She had no more fever and the antibiotics were stopped after six weeks. Conclusion We reported the case of a severe endocarditic involvement of the mitral valve in a patient with known valvular prolapse, who did not take any antibiotic before a minor dental procedure. 2015 ESC guidelines on Endocarditis recommend to not perform antibiotic prophylaxis in patient with no valvular prosthesis but with other form of valvular disease, including mitral valve prolapse (Class III, level of evidence C). Most of the time, patients with other form of valvular disease (e.g. mitral valve prolapse, bicuspid aortic valve, calcific aortic stenosis) do not experience endocarditis, neither after dental procedures. However, this case shows that sometimes it can happen due to the abnormal conformation of the native valve and, hence, it makes us wonder whether the antibiotic therapy should be indicated before dental procedures in those kind of patients. Abstract P1304 Figure.

Equivalent Short-term Outcomes for Minimally Invasive Repair of Anterior, Posterior and Bi-Leaflet Mitral Valve Prolapse

2016 ◽  
Vol 25 (8) ◽  
pp. e95
Author(s):  
Simone Chin ◽  
Mark Connellan ◽  
Hemant Pathare ◽  
Hong Chew ◽  
Emily Granger ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Prolapse ◽  
Short Term ◽  
Anterior Posterior

Home-based crisis team in North Cork service description and patient-related outcomes

2017 ◽  
Vol 36 (1) ◽  
pp. 29-33
Author(s):  
G. Lalevic ◽  
A. Suhail ◽  
H. Doyle
Keyword(s):  
Hospital Admission ◽  
Mental Health Problems ◽  
Psychiatric Inpatient ◽  
Service Description ◽  
Short Term ◽  
The North ◽  
Home Based ◽  
Psychiatric Inpatient Unit ◽  
Period Data

ObjectiveHome-based crisis team (HBCT) in North Cork was established in 2013 to provide short term, intensive home treatment to people who are experiencing acute mental health problems, with the aim of averting hospital admission wherever possible or supporting patients discharged from hospital.MethodsA retrospective descriptive study design was adopted to describe the activities of the North Cork HBCT over a 1 year period. Data were analysed using R version 3.4.0 for Windows.ResultsA total of 388 patients were referred to the HBCT in 2015, of which 328 required assessments. General practitioners (GPs) made 56% of all referrals. The most common referral reason was low mood (40%). Stepped-up care to the psychiatric inpatient unit was required for 12.4% of patients, 62% were discharged to the outpatient clinic for routine follow-up.ConclusionMany common psychiatric presentations can be managed at home with the support of the HBCT although hospital admission is required for significant numbers.

Excavations at Alchester, 1928

1932 ◽  
Vol 12 (1) ◽  
pp. 35-67 ◽  
Author(s):  
J. H. Iliffe
Keyword(s):  
Ground Plan ◽  
North East ◽  
The North ◽  
Primary Object ◽  
External Angle ◽  
The Town ◽  
Heavy Structure

The primary object of the work of 1928 was to follow up the discovery in 1927 of the unexpectedly strong and heavy foundation underlying the north-east corner mound. As a result of this year's work it is evident that this corner mound represents some heavy structure which is best explained as a circular corner tower built into the town walls at their northeast angle; but even its foundations were so broken up that it was impossible to discover any outline or recover a complete ground plan. Oh the outside, instead of extending beyond the walls themselves, the circumference of the structure lay flush with the curved external angle of the walls, while on the inside its circumference projected slightly beyond the angle of the walls proper. It was thus rather an internal than an external tower, a fact which it is important to bear in mind.

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