The floppy mitral valve. Study on pathogenesis.

Olsen, E. G. J.; Al-Rufaie, H K

doi:10.1136/hrt.44.6.674

Cited by 66 publications

(12 citation statements)

References 40 publications

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“…5) Olsen, et al examined the range of the extent of the spongiosa and reported that the percentage of the Spongiosa in relation to the valve thickness was variable but almost 10%-20% in the normal valve and over 60% in floppy valve syndrome. 24) In this study, we demonstrated that there was a distinct difference between these two entities by measurement of valve thickness and quantification of the contained mucopolysaccharide. The valve thickness of BML was thicker than FED (2458 ± 1356.1 mm vs. 1332 ± 685.8 mm) and the proportion of the Spongiosa in the BML group was over 50%, while 30% in the FED group.…”

Section: Pathohistological Change Of Degenerative Mitral Valve Diseasementioning

confidence: 96%

Clinical and Pathological Features of Degenerative Mitral Valve Disease: Billowing Mitral Leaflet Versus Fibroelastic Deficiency

Matsumaru

Eishi

Hashizume

et al. 2014

Ann Thorac Cardiovasc Surg

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Section: Pathohistological Change Of Degenerative Mitral Valve Diseasementioning

confidence: 96%

Clinical and Pathological Features of Degenerative Mitral Valve Disease: Billowing Mitral Leaflet Versus Fibroelastic Deficiency

Matsumaru

Eishi

Hashizume

et al. 2014

Ann Thorac Cardiovasc Surg

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“…Valvular thickening with fissured surfaces or fibrosis also can serve as a nidus for thrombus formation. 22 Recently, gross inspection of a mitral valve removed during a mitral valve replacement at our institution and with documented echo strands by transesophageal echocardiography revealed the strands to be consistent with Lambl's excrescences (pathology report). Lambl's excrescences are filiform processes found on both mitral and aortic valves.…”

Section: Discussionmentioning

confidence: 99%

Enhanced detection of intracardiac sources of cerebral emboli by transesophageal echocardiography.

Lee

Bartzokis

Yeoh

et al. 1991

Stroke

210

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We performed transesophageal echocardiography in 50 consecutive hospitalized patients with recent transient ischemic attack or stroke of embolic origin to determine whether transesophageal echocardiography is more sensitive than transthoracic echocardiography in detection of possible intracardiac sources of embolism. Twenty-six of 50 patients with a negative transthoracic echocardiogram for potential source of emboli had a transesophageal echocardiography study that demonstrated at least one intracardiac abnormality. Abnormalities noted by transesophageal echocardiography included five of 50 patients with either a left atrial or left atrial appendage clot, four patients with a patent foramen ovale, and nine patients with spontaneous echocardiographic contrast In 11 of 50 patients with no other source of embolism, we found highly mobile filamentous strands on the mitral valve, which have not been described previously. These mitral valve echo strands may represent a fissured surface or fibrosis that can serve as a nidus for thrombus formation. We detected no unexpected left ventricular thrombus or left atrial myxoma. Factors significantly associated with a greater likelihood of a positive transesophageal echocardiography study included left atrial enlargement, atrial fibrillation, and a calcified or thickened mitral valve. Our study suggests that transesophageal echocardiography is a valuable addition to transthoracic echocardiography in investigating potential intracardiac sources of embolism. (Stroke 1991^2:734-739)

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“…The diagnosis of an idiopathic form of isolated rupture of the chordae tendineae was confirmed by operative and pathologic findings. We excluded the patients with chordal rupture due to bacterial endocarditis of various etiologies and of valvular heart disease (including a floppy mitral valve).6), 7) Immediately after the excision of the mitral valves during open heart surgery, both the ruptured and the macroscopically intact chordae were resected separately. Normal chordae, used as the control for comparative study, were obtained at necropsy from 5 patients who died from extracardiac causes.…”

Section: Methodsmentioning

confidence: 99%

Scanning and transmission electron microscopic studies on isolated ruptures of chordae tendineae.

Lee

Chen

et al. 1983

Jpn Heart J

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Electron microscopic studies of chordae tendineae of the mitral valve were carried out in 17 patients who underwent mitral valve replacement due to a spontaneously isolated rupture of chordae tendineae. The normal chordae, used as the control group, were obtained at autopsy from 5 patients who died from extracardiac causes and were compared with the ruptured chordae. In all patients with chordal rupture, scanning electron microscopy showed perforations of the chordae tendineae, with extensive desquamation and disruption of the endothelial cells and wide-spread destruction of the collagen fiber bundles in the central collagenous core. These pathological findings were not observed in the normal chordae from the control group. Transmission electron microscopy showed that the ruptured chordae were characterized by heterogeneous collagen fibrils with intrinsic structural alterations and disorganization in fibril arrangement. There was a wide variation in the diameters of collagen fibrils which always showed abnormal morphology, with abnormally large, peculiarly shaped fibrils. Apparent loss and/or a disordered arrangement of the typical periodicity of the fibrils were frequently observed. In addition, various degrees of degenerative changes of collagen tissue were often present. These abnormalities were never seen in the fibrils of the normal chordae, and were observed consistently in both the fibrils of the ruptured chordae and in the macroscopically intact chordae in the group with spontaneous rupture of chordae tendineae. These results suggest that a defective organization of collagen into fibrils and fibers, associated with secondary degeneration of collagen within the central collagenous core of the chordae tendineae, are important pathogenetic mechanisms for spontaneously isolated ruptures of chordae tendineae.

show abstract

The floppy mitral valve. Study on pathogenesis.

Cited by 66 publications

References 40 publications

Clinical and Pathological Features of Degenerative Mitral Valve Disease: Billowing Mitral Leaflet Versus Fibroelastic Deficiency

Clinical and Pathological Features of Degenerative Mitral Valve Disease: Billowing Mitral Leaflet Versus Fibroelastic Deficiency

Enhanced detection of intracardiac sources of cerebral emboli by transesophageal echocardiography.

Scanning and transmission electron microscopic studies on isolated ruptures of chordae tendineae.

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