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Postnatal Growth Restriction in Mice Alters Cardiac Protein Composition and Leads to Functional Impairment in Adulthood. Int J Mol Sci 2020; 21:ijms21249459. [PMID: 33322681 PMCID: PMC7763900 DOI: 10.3390/ijms21249459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 12/18/2022] Open
Abstract
Postnatal growth restriction (PGR) increases the risk for cardiovascular disease (CVD) in adulthood, yet there is minimal mechanistic rationale for the observed pathology. The purpose of this study was to identify proteomic differences in hearts of growth-restricted and unrestricted mice, and propose mechanisms related to impairment in adulthood. Friend leukemia virus B (FVB) mouse dams were fed a control (CON: 20% protein), or low-protein (LP: 8% protein) isocaloric diet 2 weeks before mating. LP dams produce 20% less milk, inducing growth restriction. At birth (postnatal; PN1), pups born to dams fed the CON diet were switched to LP dams (PGR group) or a different CON dam. At PN21, a sub-cohort of CON (n = 3 males; n = 3 females) and PGR (n = 3 males; n = 3 females) were euthanized and their proteome analyzed by two-dimensional differential in-gel electrophoresis (2D DIGE) and mass spectroscopy. Western blotting and silver nitrate staining confirmed 2D DIGE results. Littermates (CON: n = 4 males and n = 4 females; PGR: n = 4 males and n = 4 females) were weaned to the CON diet. At PN77, echocardiography measured cardiac function. At PN80, hearts were removed for western blotting to determine if differences persisted into adulthood. 2D DIGE and western blot confirmation indicated PGR had reductions in p57kip2, Titin (Ttn), and Collagen (Col). At PN77, PGR had impaired cardiac function as measured by echocardiography. At PN80, western blots of p57kip2 showed protein abundance recovered from PN21. PN80 silver staining of large molecular weight proteins (Ttn and Col) was reduced in PGR. PGR reduces cell cycle activity at PN21, which is recovered in adulthood. However, collagen fiber networks are altered into adulthood.
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Chang YS, Tai MC, Weng SF, Wang JJ, Tseng SH, Jan RL. Risk of Mitral Valve Prolapse in Patients with Keratoconus in Taiwan: A Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176049. [PMID: 32825286 PMCID: PMC7503773 DOI: 10.3390/ijerph17176049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 02/04/2023]
Abstract
This retrospective, nationwide, matched-cohort study included 4488 new-onset keratoconus (KCN) patients, ≥12 years old, recruited between 2004 and 2011 from the Taiwan National Health Insurance Research Database. The control group included 26,928 non-KCN patients selected from the Taiwan Longitudinal Health Insurance Database 2000. Information for each patient was collected and tracked from the index date until December 2013. The incidence rate of mitral valve prolapse (MVP) was 1.77 times (95% confidence interval (CI) = 1.09–2.88; p = 0.0206) higher in KCN patients ≥40 years old and 1.49 times (95% CI = 1.12–1.98; p = 0.0060) higher in female KCN patients than in controls. After using the Cox proportional hazard regression analysis to adjust for potential confounders, including hypertension, hyperlipidemia, and congestive heart failure, KCN maintained an independent risk factor, MVP being 1.77 times (adjusted hazard ratio (HR) = 1.77, 95% CI = 1.09–2.88) and 1.48 times (adjusted HR = 1.48, 95% CI = 1.11–1.97) more likely to develop in patients ≥40 years old and female patients in the study cohort, respectively. We found that KCN patients ≥40 years of age and female KCN patients have increased risks of MVP. Therefore, it is recommended that KCN patients should be alerted to MVP.
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Affiliation(s)
- Yuh-Shin Chang
- Department of Ophthalmology, Chi Mei Medical Center, Tainan 710, Taiwan; (Y.-S.C.); (S.-H.T.)
- Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan 711, Taiwan
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan 710, Taiwan;
| | - Sung-Huei Tseng
- Department of Ophthalmology, Chi Mei Medical Center, Tainan 710, Taiwan; (Y.-S.C.); (S.-H.T.)
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Ren-Long Jan
- Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan 711, Taiwan
- Department of Pediatrics, Chi Mei Medical Center, Liouying, Tainan 736, Taiwan
- Correspondence: ; Tel.: +886-6-622-6999 (ext. 77601); Fax: +886-6-283-2639 (ext. 77610)
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Madhurapantula RS, Krell G, Morfin B, Roy R, Lister K, Orgel JP. Advanced Methodology and Preliminary Measurements of Molecular and Mechanical Properties of Heart Valves under Dynamic Strain. Int J Mol Sci 2020; 21:E763. [PMID: 31991583 PMCID: PMC7037596 DOI: 10.3390/ijms21030763] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/15/2020] [Accepted: 01/21/2020] [Indexed: 11/16/2022] Open
Abstract
Mammalian heart valves are soft tissue assemblies with multi-scale material properties. This is because they are constructs comprising both muscle and non-contractile extracellular matrix proteins (such as collagens and proteoglycans) and transition regions where one form of tissue structure becomes another, significantly different form. The leaflets of the mitral and tricuspid valves are connected to chordae tendinae which, in turn, bind through papillary muscles to the cardiac wall of the ventricle. The transition regions between these tissue subsets are complex and diffuse. Their material composition and mechanical properties have not been previously described with both micro and nanoscopic data recorded simultaneously, as reported here. Annotating the mechanical characteristics of these tissue transitions will be of great value in developing novel implants, improving the state of the surgical simulators and advancing robot-assisted surgery. We present here developments in multi-scale methodology that produce data that can relate mechanical properties to molecular structure using scanning X-ray diffraction. We correlate these data to corresponding tissue level (macro and microscopic) stress and strain, with particular emphasis on the transition regions and present analyses to indicate points of possible failure in these tissues.
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Affiliation(s)
- Rama S. Madhurapantula
- Department of Biology, Illinois Institute of Technology, Chicago, IL 60616, USA;
- Pritzker Institute of Biomedical Science and Engineering, Illinois Institute of Technology, Chicago, IL 60616, USA;
| | - Gabriel Krell
- Pritzker Institute of Biomedical Science and Engineering, Illinois Institute of Technology, Chicago, IL 60616, USA;
| | - Berenice Morfin
- Department of Biology, Illinois Institute of Technology, Chicago, IL 60616, USA;
| | - Rajarshi Roy
- Corvid Technologies, Mooresville, NC 28117, USA; (R.R.); (K.L.)
| | - Kevin Lister
- Corvid Technologies, Mooresville, NC 28117, USA; (R.R.); (K.L.)
| | - Joseph P.R.O. Orgel
- Department of Biology, Illinois Institute of Technology, Chicago, IL 60616, USA;
- Pritzker Institute of Biomedical Science and Engineering, Illinois Institute of Technology, Chicago, IL 60616, USA;
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL 60616, USA
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Duru N, Haşhaş OE, Göktaş E, Duru Z, Arifoğlu HB, Ulusoy DM, Karatepe Haşhaş AS, Ataş M. Corneal Sublayers Thickness in Patients With Mitral Valve Prolapse. Eye Contact Lens 2016; 44:55-59. [PMID: 27541972 DOI: 10.1097/icl.0000000000000300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to compare the thickness of each corneal sublayer in patients with mitral valve prolapse (MVP) and healthy individuals. METHODS A total of 38 eyes from 38 patients with MVP and 34 eyes from 34 age- and sex-matched healthy individuals were included in this study. The thickness of the corneal epithelium, Bowman layer, stroma, and Descemet membrane-endothelium complex were measured on the central cornea (i.e., corneal apex) and both the inferior and superior halves of the cornea with anterior segment module of spectral domain optical coherence tomography. RESULTS No statistically significant differences emerged between the study and control groups in terms of Bowman layer thickness in the central cornea and the cornea's superior half (P=0.092 and P=0.128, respectively). However, in the inferior half of the cornea, Bowman layer thickness among patients with MVP was 11.95±2.34 μm (range 7-16 μm) and in the control group was 13.03±1.62 μm (range 10-16 μm), which made for a statistically significant difference (P=0.025). CONCLUSIONS Our study revealed thinning of Bowman layer in the inferior half of the cornea in patients with MVP.
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Affiliation(s)
- Necati Duru
- Department of Ophthalmology (N.D., E.G., Z.D., H.B.A., D.M.U., A.S.K.H., M.A.), Kayseri Education and Research Hospital, Kayseri, Turkey; Department of Cardiovascular Surgery (O.E.H.), Kayseri Education and Research Hospital, Kayseri, Turkey
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Impaired corneal biomechanical properties and the prevalence of keratoconus in mitral valve prolapse. J Ophthalmol 2014; 2014:402193. [PMID: 24864193 PMCID: PMC4016888 DOI: 10.1155/2014/402193] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 03/26/2014] [Accepted: 03/31/2014] [Indexed: 11/18/2022] Open
Abstract
Objective. To investigate the biomechanical characteristics of the cornea in patients with mitral valve prolapse (MVP) and the prevalence of keratoconus (KC) in MVP. Materials and Methods. Fifty-two patients with MVP, 39 patients with KC, and 45 control individuals were recruited in this study. All the participants underwent ophthalmologic examination, corneal analysis with the Sirius system (CSO), and the corneal biomechanical evaluation with Reichert ocular response analyzer (ORA). Results. KC was found in six eyes of four patients (5.7%) and suspect KC in eight eyes of five patients (7.7%) in the MVP group. KC was found in one eye of one patient (1.1%) in the control group (P = 0.035). A significant difference occurred in the mean CH and CRF between the MVP and control groups (P = 0.006 and P = 0.009, resp.). All corneal biomechanical and topographical parameters except IOPcc were significantly different between the KC-MVP groups (P < 0.05). Conclusions. KC prevalence is higher than control individuals in MVP patients and the biomechanical properties of the cornea are altered in patients with MVP. These findings should be considered when the MVP patients are evaluated before refractive surgery.
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Dudakova L, Jirsova K. The impairment of lysyl oxidase in keratoconus and in keratoconus-associated disorders. J Neural Transm (Vienna) 2013; 120:977-82. [PMID: 23653221 DOI: 10.1007/s00702-013-0993-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 02/05/2013] [Indexed: 01/01/2023]
Abstract
Keratoconus (KC) is an eye disease characterized by the progressive thinning and protrusion of the cornea, which results in the loss of visual acuity. This disorder remains poorly understood, although recent studies indicate the involvement of genetic and environmental factors. Recently, we have found that the distribution of the cross-linking enzyme lysyl oxidase (LOX) is markedly decreased in about 63 % of keratoconic specimens. Similarly, LOX activity is significantly reduced by 38 % compared to control tissue. Nearly 70 systemic disorders have been reported in association with KC, most of them affecting the extracellular matrix. In this review we attempted to ascertain whether any KC-associated diseases exhibit signs that may reflect LOX impairment. We hypothesized that very similar changes in the extracellular matrix, particularly at the level of collagen metabolism, including LOX impairment in mitral leaflets, may reflect an association between KC and mitral valve prolapse. Moreover, this putative association is supported by the high frequency of Down syndrome in both diseases. Among other disorders that have been found to coincide with KC, we did not find any in which the LOX enzyme may be directly or indirectly impaired. On the other hand, in cases where KC is present along with other connective tissue disorders (Marfan syndrome, Ehlers-Danlos syndrome and others), KC may not arise as a localized manifestation, but rather may be induced as the result of a more complex connective tissue disorder.
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Affiliation(s)
- Lubica Dudakova
- Laboratory of Biology and Pathology of Eye, First Faculty of Medicine, Institute of Inherited Metabolic Disorders, Charles University and General University Hospital, Prague, Czech Republic
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Non-fibrillar collagens: Key mediators of post-infarction cardiac remodeling? J Mol Cell Cardiol 2010; 48:530-7. [DOI: 10.1016/j.yjmcc.2009.06.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 06/09/2009] [Accepted: 06/21/2009] [Indexed: 11/21/2022]
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Hadian M, Corcoran BM, Han RI, Grossmann JG, Bradshaw JP. Collagen organization in canine myxomatous mitral valve disease: an x-ray diffraction study. Biophys J 2007; 93:2472-6. [PMID: 17557795 PMCID: PMC1965430 DOI: 10.1529/biophysj.107.107847] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Collagen fibrils, a major component of mitral valve leaflets, play an important role in defining shape and providing mechanical strength and flexibility. Histopathological studies show that collagen fibrils undergo dramatic changes in the course of myxomatous mitral valve disease in both dogs and humans. However, little is known about the detailed organization of collagen in this disease. This study was designed to analyze and compare collagen fibril organization in healthy and lesional areas of myxomatous mitral valves of dogs, using synchrotron small-angle x-ray diffraction. The orientation, density, and alignment of collagen fibrils were mapped across six different valves. The findings reveal a preferred collagen alignment in the main body of the leaflets between two commissures. Qualitative and quantitative analysis of the data showed significant differences between affected and lesion-free areas in terms of collagen content, fibril alignment, and total tissue volume. Regression analysis of the amount of collagen compared to the total tissue content at each point revealed a significant relationship between these two parameters in lesion-free but not in affected areas. This is the first time this technique has been used to map collagen fibrils in cardiac tissue; the findings have important applications to human cardiology.
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Affiliation(s)
- Mojtaba Hadian
- Veterinary Biomedical Sciences, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Summerhall, Edinburgh EH9 1QH, United Kingdom.
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Black A, French AT, Dukes-McEwan J, Corcoran BM. Ultrastructural morphologic evaluation of the phenotype of valvular interstitial cells in dogs with myxomatous degeneration of the mitral valve. Am J Vet Res 2005; 66:1408-14. [PMID: 16173485 DOI: 10.2460/ajvr.2005.66.1408] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate morphologic changes in valvular interstitial cells of dogs and to find evidence for disease-associated phenotypic changes in these cells. ANIMALS 5 clinically normal dogs and 5 dogs with severe mitral valve endocardiosis. PROCEDURE Mitral valve leaflets were evaluated by use of transmission electron microscopy. Differences in cell type and cell location were identified. RESULTS A change in cell type toward a myofibroblast or smooth muscle cell phenotype was detected, with the smooth muscle cell type being most common. These cells had long amorphous cytoplasmic extensions, fibrillar cytoplasm, incomplete basal lamina, few mitochondria, and eccentrically placed nuclei but lacked smooth endoplasmic reticulum or Golgi complexes. Remaining valvular interstitial cells had heterochromatic nuclei and produced only minimal quantities of collagen. Compared with normal valves, myxomatous valves ha many interstitial-like cells located adjacent to the endothelium. Deeper within the abnormal valves, cells with a heterogenous phenotype formed groupings that appeared to be anchored to adjacent collagen. CONCLUSIONS AND CLINICAL RELEVANCE Myxomatous degeneration of the mitral valve in dogs is associated with phenotypic alteration, changing from an interstitial to a mixed myofibroblast or smooth muscle cell phenotype. A closer association between interstitial cells and the endothelium is evident in diseased valves. In response to the disease process, valvular interstitial cells of dogs appear to change toward a smooth muscle phenotype, possibly in an attempt to maintain valve tone and mechanical function.
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Affiliation(s)
- Alexander Black
- Department of Anatomy, Faculty of Medicine & Health Sciences, National University of Ireland-Galway, Galway, Ireland
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Yazici M, Ataoglu S, Makarc S, Sari I, Erbilen E, Albayrak S, Yazici S, Uyan C. The relationship between echocardiographic features of mitral valve and elastic properties of aortic wall and Beighton hypermobility score in patients with mitral valve prolapse. ACTA ACUST UNITED AC 2004; 45:447-60. [PMID: 15240965 DOI: 10.1536/jhj.45.447] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The present study was designed to investigate the incidence of benign joint hypermobility syndrome (BJHMS) in mitral valve prolapse (MVP) and the correlation between the echocardiographic features of the mitral valve and elastic properties of the aortic wall and Beighton hypermobility score (BHS) in patients with MVP and BJHMS. Fourty-six patients with nonrheumatic, uncomplicated, and isolated mitral anterior leaflet prolapse (7 men and 39 women, mean age; 26.1 +/- 5.9) and 25 healthy subjects (3 men and 22 women, mean age, 25.4 +/- 4.3) were studied. Patients were divided into two groups according to their BHS (group I, MVP+BJHMS; group II, MVP-BJHMS). Individuals with accompanying cardiac or systemic disease were excluded. Echocardiographic examination was performed in all subjects. The presence of BJHMS was evaluated according to Beighton's criteria. The incidence of BJHMS in patients with MVP was found to be significantly higher than that of controls (45.6%, (21/46) vs 12% (3/25), P < 0.0001). Group I (MVP + BJHMS) had significantly increased anterior mitral leaflet thickness (AMLT, 3.4 +/- 0.4 vs 3.1 +/- 0.3; P < 0.005), maximal leaflet displacement (MLD, 2.4 +/- 0.4 vs 1.7 +/- 0.4; P < 0.005), and degree of mitral regurgitation (DMR, 17.1 +/- 7.2 vs 11.2 +/- 4.4; P < 0.01) compared to group II. However, the index of aortic stiffness (IAOS) was found to be lower (17.6 +/- 6.9 vs 23.9 +/- 7.6; P < 0.005) and aortic distensibility (AOD) to be higher (0.0035 +/- 0.007 vs 0.0024 +/- 0.005; P < 0.005) in group I. There was a significant correlation between AMLT, MLD and DMR, and BHS (r = 0.57/P = 0.007, r = 0.55/P < 0.009, r = 0.51/P < 0.01, respectively). In addition, AOD correlated positively with BHS (r = 0.53/P < 0.005), but the index of aortic stiffness correlated inversely with BHS (r = -0.49/P < 0.007). The incidence of BJHMS in patients with MVP was more frequent than the normal population and there was a significant correlation between the severity of BJHMS (according to BHS) and echocardiographic features of the mitral leaflets and elastic properties of the aortic wall.
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Affiliation(s)
- Mehmet Yazici
- Department of Cardiology, School of Medicine, Abant Izzet Baysal University, Duzce, Turkey
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Fujiki M, Misumi K, Sakamoto H. Evaluation of collagenase-induced mitral valve regurgitation in dogs. Am J Vet Res 2000; 61:1593-8. [PMID: 11131604 DOI: 10.2460/ajvr.2000.61.1593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the hemodynamic changes induced by injecting collagenase into the mitral valve to induce mitral valve regurgitation (MVR) in dogs. ANIMALS 9 healthy Beagles. PROCEDURE Dogs were randomly assigned to 3 groups: control (saline [0.9% NaCl] solution; n = 3), single collagenase injection (C1; 3), and 2 collagenase injections (C2; 3). Open-heart surgery was performed, and saline or collagenase solutions were injected into the mitral valve. Before and weekly for 11 weeks after surgery, radiography, echocardiography, and phonocardiography were performed. Mean pulmonary arterial pressure and mean pulmonary arterial wedge pressure (mPAWP) were measured before and 11 weeks after surgery. Postmortem examinations were performed after dogs were euthanatized. RESULTS No changes were detected in the control group during the 11-week follow-up period. A systolic murmur and MVR developed 1 week after surgery in groups C1 and C2. The murmur changed from a protosystolic to a pansystolic murmur, and left atrial diameter and the left atrial-to-aortic root diameter ratio increased with time. Mean pulmonary arterial pressure and mPAWP were greater 11 weeks after surgery in groups C1 and C2, compared with presurgery values. During necropsy, tissue loss was detected in the mitral valve at the site of collagenase injection. Degree of regurgitation corresponded to lesion size. CONCLUSIONS AND CLINICAL RELEVANCE Injection of collagenase into the mitral valve of healthy dogs induced MVR, and dogs with MVR developed progressive hemodynamic changes without acute overload. Collagenase-induced MVR may be an appropriate model for evaluation of prognostic markers of idiopathic MVR in dogs.
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Affiliation(s)
- M Fujiki
- Department of Veterinary Medicine, Faculty of Agriculture, Kagoshima University, Japan
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Akhtar S, Meek KM, James V. Ultrastructure abnormalities in proteoglycans, collagen fibrils, and elastic fibers in normal and myxomatous mitral valve chordae tendineae. Cardiovasc Pathol 1999; 8:191-201. [PMID: 10724523 DOI: 10.1016/s1054-8807(99)00004-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Normal and myxomatous chordae tendineae were studied using light and electron microscopy, to assess the alterations in the appearance and mutual arrangement of proteoglycans, collagen fibrils, and elastic fibers. Specific staining with ruthenium red and cuprolinic blue in a critical electrolyte concentration mode were used to localize proteoglycans. Fresh tissues were fixed in glutaraldehyde containing the cationic dyes and embedded into Spurr resin. Semithin sections of LR White (London Resin Co., Basingstoke, U.K.)-embedded tissue were used for histochemistry. In normal chordae tendineae, the fibrosa comprised close-packed collagen fibrils intermixed with elastic fibers. These were surrounded by a thin layer of elastic fibers and collagen fibrils, both of which were closely associated with proteoglycans. In myxomatous chordae tendineae, alterations were observed in the connective tissue. Proteoglycans were more abundant and were distributed throughout the tissue. The outermost layer was transformed into an undifferentiated electron-dense mass surrounding the central fibrosa, which contained degraded elastic fibers and collagen fibrils. Collagen fibrils had faint banding or lacked a banding pattern altogether. Spaces between collagen fibrils were occupied by abnormal proteoglycans or proteoglycan aggregates. Elastic fibers showed varying degrees of degeneration and were occasionally replaced by electron-lucent spaces containing microfibrils. Accumulation of abnormal proteoglycan was also observed around degenerated elastic fibres and collagen fibrils.
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Affiliation(s)
- S Akhtar
- Open University, Oxford Research Unit, United Kingdom
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Fornes P, Heudes D, Fuzellier JF, Tixier D, Bruneval P, Carpentier A. Correlation between clinical and histologic patterns of degenerative mitral valve insufficiency: a histomorphometric study of 130 excised segments. Cardiovasc Pathol 1999; 8:81-92. [PMID: 10724505 DOI: 10.1016/s1054-8807(98)00021-0] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The objectives of this study were to examine quantitatively the histological changes in incompetent degenerative mitral valves obtained at surgery for mitral valve repair, and to determine whether Barlow's disease (BD) and fibroelastic deficiency (FED) can be distinguished by histology. The billowing mitral leaflet syndrome (or Barlow's disease) and FED can be distinguished on the basis of clinical patterns and gross features, but their histologic patterns have not been described. One hundred thirty patients were studied. Thirty-nine (24 males) had BD; 44 (38 males) FED; 15 (7 males) Marfan's syndrome (MS); and 32 patients (25 males) a non-determined degenerative disease. Histological changes of the resected segment of the valve were quantitatively evaluated using scores of severity. A discriminant analysis was performed. The groups defined by the computer were checked for concordance with groups defined by the surgeon. Collagen alterations were found the most severe in MS patients. BD and MS had the most myxoid infiltration. MS and FED patients had the most elastic fiber alterations. No BD in males and only one in females were misclassified by the discriminant procedure into the FED group. Overall, the percentages of correct matchings were 54% in males and 62% in females. When the age of patients and the size of ring were added to histology to determine whether this additional information provided more discrimination, the percentages of correct matchings reached 90% in males and 100% in females. BD and FED are two fairly distinct entities, which can be distinguished by quantitative histology, whereas only modest differences were found in qualitative histology.
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Affiliation(s)
- P Fornes
- Department of Pathology, Broussais Hospital, Paris, France.
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Gagna C, Meier D, Ru G, Pospischil A, Guarda F. Pathology of mitral valve in regularly slaughtered pigs: an abattoir survey on the occurrence of myxoid degeneration (endocardiosis), fibrosis and valvulitis. ZENTRALBLATT FUR VETERINARMEDIZIN. REIHE A 1998; 45:383-95. [PMID: 9793469 DOI: 10.1111/j.1439-0442.1998.tb00841.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this study was to report the prevalence of degenerative and early inflammatory lesions and to discuss some histological aspects of normal and pathological mitral valve leaflets in healthy, normally slaughtered pigs. Mitral valves were collected from 112, 6 month-old, pigs reared under different conditions. Histological examination revealed the presence of myxoid degeneration in 29.5% of the valves with no significantly different prevalence according to rearing conditions; fibrosis was present in 12.5%; inflammation (non-vegetative valvulitis) occurred in 20 (17.9%) macroscopically normal valves. No vegetative endocarditis could be observed. A significantly higher degree of inflammation was observed in valves affected by myxoid degeneration (P < 0.05) and Anitschkow cells were prevalent in all the pathological valves (P < 0.01). Capillaries were observed in a wide majority of the valves (86.5%), but small arterioles were related to fibrotic thickening of the leaflets (P < 0.01). The following conclusions are discussed: (1) environmental factors seem not to influence the prevalence of endocardiosis; (2) inflammatory foci in myxoid valves are a reaction to both abnormal friction and products of degraded collagen and extracellular matrix; (3) the authors consider the presence of capillaries in pig valves a normal finding whereas proliferation of the vessels occurs under pathological conditions; (4) non vegetative valvulitis can be related to the presence of vessels in the valve and may have a role in both infectious endocarditis and fibrosis; (5) Anitschkow cells are normally observed in pig valves and are not specifically related to pathological lesions.
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Affiliation(s)
- C Gagna
- Department of Animal Pathology, School of Veterinary Medicine, State University of Torino, Italy
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Castagnaro M, Amedeo S, Bertolotto A, Manzardo E, Riccio A, Guarda F. Morphological and biochemical investigations of mitral valve endocardiosis in pigs. Res Vet Sci 1997; 62:121-5. [PMID: 9243709 DOI: 10.1016/s0034-5288(97)90132-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pig endocardiosis is a pathological process affecting cardiac valves that is characterised by the accumulation of glycosaminoglycans (GAG) in the extracellular matrix. To investigate the involvement of GAG in the condition, the morphology of the mitral valves from 23 affected pigs and seven normal controls was studied and qualitative and quantitative biochemical analyses of GAG were made. Gross and histopathological lesions were characterised by valve enlargement, collagen disorganisation and myxoid degeneration. No differences between normal and diseased valves were detected by lectin histochemistry. Electron microscopy revealed myofibroblast differentiation of many fibroblasts. A statistically significant increase of total GAG and hyaluronan was detected in the mitral valves of the pigs with endocardiosis by spectrophotometric, electrophoretic and densitometric analysis of the extracted GAG. Although it is not known whether the change in hyaluronan is a primary event or a result of other changes in the extracellular matrix, its accumulation in association with myofibroblast differentiation suggests that it plays a pathogenetic role in pig endocardiosis.
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Affiliation(s)
- M Castagnaro
- Department of Animal Pathology, School of Veterinary Medicine, State University of Torino, Italy
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18
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Norton LA, Assael LA. Orthodontic and temporomandibular joint considerations in treatment of patients with Ehlers-Danlos syndrome. Am J Orthod Dentofacial Orthop 1997; 111:75-84. [PMID: 9009927 DOI: 10.1016/s0889-5406(97)70305-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The gross clinical manifestations, the classifications of the syndrome, and a summary of the pathophysiology are presented. Dental manifestations are described with an emphasis on the orthodontic and temporomandibular joint problems found in the disease. Finally, there are short clinical reports of orthodontic and surgical temporomandibular joint treatments.
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Affiliation(s)
- L A Norton
- Department of Orthodontics, University of Connecticut Health Center, School of Dental Medicine, Farmington 06030, USA
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19
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Abstract
Fifty patients with advanced degrees of keratoconus, requiring corneal transplantation, were sreened for mitral valve prolapse by two dimensional echocardiography. The overall prevalence of 58% was found to be statistically higher than the prevalence of 7% found in a group of age and sex-matched controls. It was also found to be higher than the previously reported prevalence of 38% in a group of keratoconus patients with similar age and sex match to our series. The findings of our study in conjunction with the histopathological and biochemical similarities between the two conditions strongly suggest that they may be different manifestations of similar defects in collagen metabolism.
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Affiliation(s)
| | - T A Casey
- Corneo-plastic Unit, Queen Victoria Hospital, East Grinstead, West Sussex RH19 3DZ
| | - J Coltart
- Department of Cardiology, St Thomas' Hospital London SE1 7EH
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20
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Morales AR, Romanelli R, Boucek RJ, Tate LG, Alvarez RT, Davis JT. Myxoid heart disease: an assessment of extravalvular cardiac pathology in severe mitral valve prolapse. Hum Pathol 1992; 23:129-37. [PMID: 1740297 DOI: 10.1016/0046-8177(92)90233-s] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Because of the microscopic features of the affected leaflets in mitral valve prolapse (MVP), myxoid degeneration of the valve is a common pathologic designation applied to this condition. We undertook this study as a means of gaining an insight into the occurrence and prevalence of extravalvular cardiac alterations in hearts with severe MVP. Tissues of 24 hearts with severe myxomatous transformation of the mitral valve as the sole cardiac abnormality were examined. Eighteen of the 24 subjects with severe MVP died suddenly. Only two of these had pathologic evidence of severe mitral insufficiency. Twenty-four normal hearts served as controls. The two groups of hearts came from victims of homicide, suicide, accident, or natural death. Sections of the mitral valve, working myocardium, conduction system, and cardiac nerves and ganglia were studied by routine and special connective tissue and proteoglycan stains. Similar to the findings in severely affected mitral valves, prominent deposits of proteoglycans in neural and conduction tissue readily distinguished hearts with myxomatous valve changes from the control hearts. We conclude that the commonly recognized local derangement of valvular tissue in MVP is but one specific reflection of a more general myxomatous alteration in cardiac connective tissue.
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Affiliation(s)
- A R Morales
- Department of Pathology, University of Miami School of Medicine, FL
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21
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Boudoulas H, Kolibash AJ, Baker P, King BD, Wooley CF. Mitral valve prolapse and the mitral valve prolapse syndrome: a diagnostic classification and pathogenesis of symptoms. Am Heart J 1989; 118:796-818. [PMID: 2679016 DOI: 10.1016/0002-8703(89)90594-2] [Citation(s) in RCA: 96] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- H Boudoulas
- Division of Cardiology, Ohio State University, Columbus 43210
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22
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Affiliation(s)
- A Ansari
- Department of Medicine, Section Cardiology, Metropolitan Medical Center, Minneapolis, MN
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23
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Henney AM, Tsipouras P, Schwartz RC, Child AH, Devereux RB, Leech GJ. Genetic evidence that mutations in the COL1A1, COL1A2, COL3A1, or COL5A2 collagen genes are not responsible for mitral valve prolapse. BRITISH HEART JOURNAL 1989; 61:292-9. [PMID: 2930668 PMCID: PMC1216661 DOI: 10.1136/hrt.61.3.292] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
DNA markers were used to assess the segregation of genes encoding the collagen types that predominate in the mitral valve (types I, III, and V) in two family pedigrees that are phenotypically different but showed dominantly inherited mitral valve prolapse. The inheritance of these markers was compared with the segregation of the phenotype for mitral valve prolapse in both families. In one family it was shown that the COL1A1, COL1A2, COL3A1, and COL5A2 genes segregated independently of the phenotype; in the other family the results for COL1A1, COL1A2, and COL5A2 were similar but analysis at the COL3A1 locus was not possible. These data indicate that in these families mitral valve prolapse does not arise from a defect in one of these collagen genes.
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Affiliation(s)
- A M Henney
- Strangeways Research Laboratory, Cambridge
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24
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Abstract
Myxoid heart disease (MHD), more commonly known as mitral valve prolapse, is a very common cardiac abnormality affecting 5-10% of the general population. This article reviews the history, symptoms, physical findings, pathology, associated conditions and complications of this entity. Special emphasis is given to sudden cardiac death, which occurs as a result of acute heart failure or due to a fatal arrhythmia. Theories regarding the origin of the arrhythmias are discussed. Once the origin is known, those at risk for this devastating complication can be identified and perhaps a preventative therapeutic regimen developed.
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Affiliation(s)
- E H Scheurman
- Office of the District Medical Examiner, Fort Myers, FL 33901
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25
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Hossack KF, Leddy CL, Johnson AM, Schrier RW, Gabow PA. Echocardiographic findings in autosomal dominant polycystic kidney disease. N Engl J Med 1988; 319:907-12. [PMID: 3419455 DOI: 10.1056/nejm198810063191404] [Citation(s) in RCA: 132] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Echocardiography, including Doppler analysis, was performed to assess the prevalence of cardiac abnormalities in 163 patients with autosomal dominant polycystic kidney disease, 130 unaffected family members, and 100 control subjects. In these three groups, the prevalence of mitral-valve prolapse was 26, 14, and 2 percent, respectively (P less than 0.0005). A higher prevalence of mitral incompetence (31, 14, and 9 percent, respectively; P less than 0.005), aortic incompetence (8, 3, and 1 percent, respectively; P less than 0.05), tricuspid incompetence (15, 7, and 4 percent, respectively; P less than 0.02), and tricuspid-valve prolapse (6, 2, and 0 percent, respectively; P less than 0.02) was also found in the patients with polycystic kidney disease. These findings reflect the systemic nature of polycystic kidney disease and support the hypothesis that the disorder involves a defect in the extracellular matrix and the cardiac abnormalities are an expression of that defect.
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Affiliation(s)
- K F Hossack
- Department of Medicine, University of Colorado School of Medicine, Denver
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26
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Baker PB, Bansal G, Boudoulas H, Kolibash AJ, Kilman J, Wooley CF. Floppy mitral valve chordae tendineae: histopathologic alterations. Hum Pathol 1988; 19:507-12. [PMID: 3371974 DOI: 10.1016/s0046-8177(88)80195-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Pathologic studies of floppy or myxomatous mitral valves have focused primarily on changes in the valve cusps, with little attention given to the chordae tendineae. In a systematic study of the histopathology of floppy mitral valve chordae tendineae, 128 nonruptured chordae from 8 severely regurgitant floppy mitral valves were compared to 152 chordae from 10 normal control mitral valves and to 152 chordae from 8 control mitral valves with severe regurgitation due to ischemic heart disease. Collagen alterations were observed in 2% of normal mitral valve chordae and 3% of control regurgitant mitral valve chordae compared to 38% of floppy mitral valve chordae. Moderate or severe acid mucopolysaccharide accumulation was observed in 2% of normal mitral valve chordae and 3% of control regurgitant mitral valve chordae compared to 39% of floppy mitral valve chordae. Nonuniform histopathologic alterations, rare in normal and control regurgitant mitral valve chordae tendineae, were frequent in floppy mitral valve chordae tendineae (p less than 0.001). Histopathologic alterations provide the basis for abnormal physical properties previously demonstrated in floppy mitral valve chordae tendineae and may predispose to chordal elongation and rupture.
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Affiliation(s)
- P B Baker
- Department of Pathology, Ohio State University College of Medicine, Columbus
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27
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Lis Y, Burleigh MC, Parker DJ, Child AH, Hogg J, Davies MJ. Biochemical characterization of individual normal, floppy and rheumatic human mitral valves. Biochem J 1987; 244:597-603. [PMID: 3446179 PMCID: PMC1148038 DOI: 10.1042/bj2440597] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Human mitral valves (32 floppy and 17 rheumatic) obtained at surgery were analysed and compared with 35 normal (autopsy) valves. Total amounts of collagen, proteoglycan and elastin were increased approx. 3-fold in floppy and rheumatic valves. The water content of rheumatic cusps was lower than normal. The most significant changes in floppy valves were the 59% increase in mean value of the proteoglycan content, a large increase in the ease of extractability of proteoglycans from 26.7 to 57.2% of the total and a 62% increase in mean value of the elastin content in the anterior cusps. Normal human mitral valve cusps contained a mean proportion of 29.3 (and chordae 26.6) type III collagen (as % of total types III + I collagen), the values increasing significantly to 33.2 and 36.3% respectively in chronic rheumatic disease. The ratio observed in floppy valves depended on the extent of secondary surface fibrosis, which could be demonstrated histologically; in valve cusps with considerable secondary fibrosis, the percentage of type III increased significantly (to 34.4%), whereas it decreased significantly (to 25.2%) when fibrosis was negligible. It is concluded that the ratio of collagen types in floppy valves reflects the extent of secondary fibrosis rather than the pathogenesis of the disrupted collagen in the central core of the valve.
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Affiliation(s)
- Y Lis
- British Heart Foundation Cardiovascular Pathology Unit, St. George's Hospital Medical School, London, U.K
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Virmani R, Atkinson JB, Byrd BF, Robinowitz M, Forman MB. Abnormal chordal insertion: a cause of mitral valve prolapse. Am Heart J 1987; 113:851-8. [PMID: 3565236 DOI: 10.1016/0002-8703(87)90043-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Although the morphology of mitral valve prolapse (MVP) has been described, abnormalities of chordal arrangement and insertion have not been emphasized. We retrospectively reviewed 23 surgically-excised MVP and 10 control mitral valves removed at necropsy. Two-dimensional echocardiograms (2DE) were available in 10 MVP and in six additional controls. 2DE accurately assessed the length of anterior leaflet (AL) and posterior leaflet (PL) of the mitral valve (3.2 +/- 0.7 cm and 2.2 +/- 0.6 cm, respectively) as compared to morphologic measurements (3.0 +/- 0.4 cm and 2.1 +/- 0.4 cm, respectively). However, annular diameter as assessed by echocardiography was significantly less (4.6 +/- 0.7 cm) than that derived by morphologic measurements of annular circumference (AC) (5.3 +/- 0.7 cm). The AL and PL lengths and the mitral anuli were significantly larger in patients with MVP as compared to controls (p less than 0.01) when assessed both by 2DE and by morphology. The ratio of the maximum distance of chordal separation/AC was 0.11 +/- 0.04 in MVP and 0.13 +/- 0.02 in controls (p less than 0.05). Chordal divisions were increased in MVP (4.2) compared to controls (3.1, p less than 0.01). The most striking morphologic feature of MVP was abnormal chordal insertion and a random, unpredictable pattern of chordal distribution. We postulate that abnormal chordal architecture may be responsible for unequal stress on the valve leaflets and may thus lead to MVP.
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30
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Whittaker P, Boughner DR, Perkins DG, Canham PB. Quantitative structural analysis of collagen in chordae tendineae and its relation to floppy mitral valves and proteoglycan infiltration. Heart 1987; 57:264-9. [PMID: 3566985 PMCID: PMC1216423 DOI: 10.1136/hrt.57.3.264] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Imbibition analysis, a polarised light microscopy technique, was used to examine the molecular organisation of collagen in normal and diseased mitral valve chordae tendineae. A single strut chorda from each of 23 valves (14 from necropsy specimens and nine from valve replacement surgery) was studied. The degree of molecular organisation of collagen in unstained 7 micron sections of the chordae was assessed by measuring the retardation of polarised light by the sample. Sections from each tendon were examined, after staining with Movat's pentachrome, for the presence of proteoglycan infiltration and classified as normal or abnormal on that basis. The imbibition analysis results were grouped accordingly. The retardation in the collagen in the seven chordae with proteoglycan infiltration was significantly lower than in the 16 normal chordae, indicating decreased molecular organisation. Five of the seven abnormal chordae with proteoglycan infiltration and decreased retardation were from patients with floppy mitral valves; the other two were from normal necropsy specimens. Although proteoglycan infiltration may not be a specific marker for floppy valve disease, its presence is associated with decreased molecular organisation of collagen in the chordae. Degradation of the ground substance bound to the collagen is the most plausible explanation for the measured optical changes.
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31
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Devereux RB, Kramer-Fox R, Brown WT, Shear MK, Hartman N, Kligfield P, Lutas EM, Spitzer MC, Litwin SD. Relation between clinical features of the mitral prolapse syndrome and echocardiographically documented mitral valve prolapse. J Am Coll Cardiol 1986; 8:763-72. [PMID: 3760352 DOI: 10.1016/s0735-1097(86)80415-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Mitral valve prolapse, the most common inherited cardiovascular condition, has been associated with a variety of signs, symptoms and electrocardiographic abnormalities, but the true spectrum of the mitral prolapse syndrome remains in doubt because clinical findings often contribute to patient identification and their prevalence in patient groups may be overstated because of ascertainment bias. Accordingly, clinical findings in 88 patients with echocardiographic mitral prolapse were compared with those in 81 of their adult first degree relatives with mitral prolapse (a group free of ascertainment bias) and in two control groups without mitral prolapse: 172 first degree relatives and 60 spouses. Comparison of relatives with and without mitral prolapse demonstrated true associations between mitral prolapse and clicks or murmurs, or both (67 versus 9%, p less than 0.001), thoracic bony abnormalities (41 versus 16%, p less than 0.001), systolic blood pressure less than 120 mm Hg (53 versus 31%, p less than 0.001), body weight 90% or less of ideal (31 versus 14%, p less than 0.005) and palpitation (40 versus 24%, p less than 0.01). In contrast, relatives with mitral prolapse showed no significant increase over normal relatives or spouses without mitral prolapse in prevalence of chest pain, dyspnea, panic attacks, high anxiety or repolarization abnormalities, but these features were all more common in women than in men (p less than 0.01 to less than 0.001). Thus, the true spectrum of the mitral prolapse syndrome encompasses a midsystolic click and late systolic murmur, thoracic bony abnormalities, low body weight and blood pressure and palpitation. Other suggested clinical features, including nonanginal chest pain, dyspnea, panic attacks and electrocardiographic abnormalities, have appeared to be associated with mitral valve prolapse because of ascertainment bias and an erroneous classification of differences between men and women as being due to mitral valve prolapse.
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32
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Abstract
Mitral valve prolapse has been reported to be associated with a variety of neurologic disorders, including cerebral ischemia, transient global amnesia, migraine, autonomic dysfunction, and psychiatric disease. The evidence supporting these associations and possible pathogenetic mechanisms are discussed. Some neurologic disorders may be direct complications of mitral valve prolapse, while others may occur as part of an underlying genetic defect or common link.
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33
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Margaliot SZ, Barzilay J, Bar-David M, Lewis BS, Froom P, Forecast D, Gross M. Spontaneous pneumothorax and mitral valve prolapse. Chest 1986; 89:93-4. [PMID: 3940796 DOI: 10.1378/chest.89.1.93] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
We searched for mitral valve prolapse in patients with spontaneous pneumothorax to test the hypothesis that both may be part of a common disorder of connective tissue. Echocardiographic mitral valve prolapse was found in 11 (50 percent) of 22 patients who had suffered spontaneous pneumothorax compared to four (10 percent) of 40 age-matched control subjects (p less than 0.01). The body mass index (BMI) (weight/height2) was lower (p less than 0.001) in the group with pneumothorax; in five patients who were the thinnest in the study (BMI less than 2 standard deviations lower than mean normal value), mitral valve prolapse was present in four. The finding of a strong association of spontaneous pneumothorax with mitral valve prolapse, especially in subjects with an abnormal body build, suggests that in many patients, spontaneous pneumothorax may be a manifestation of a systemic abnormality of connective tissue.
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34
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Child A, Handler C, Light N, Dorrance D. Increased prevalence of mitral valve prolapse associated with an elevated skin type III/III+I collagen ratio in joint hypermobility syndrome. AGENTS AND ACTIONS. SUPPLEMENTS 1986; 18:125-9. [PMID: 3460313 DOI: 10.1007/978-3-0348-7684-1_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Handler CE, Child A, Light ND, Dorrance DE. Mitral valve prolapse, aortic compliance, and skin collagen in joint hypermobility syndrome. BRITISH HEART JOURNAL 1985; 54:501-8. [PMID: 3902069 PMCID: PMC481937 DOI: 10.1136/hrt.54.5.501] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Mitral valve prolapse was sought clinically and with phonocardiography and M mode and sector echocardiography in 15 women aged 22-57 years with joint hypermobility syndrome. The type III:III + I collagen ratio was measured in skin biopsy specimens and was found to be raised in seven of 10 patients sampled. Thirteen patients had increased aortic wall compliance measured by the continuous wave Doppler ultrasound technique. Ten (67%) patients had mitral valve prolapse shown by auscultatory signs or echocardiography or both--a prevalence at least three times greater than that in the general adult population. It is concluded that if the abnormality of collagen biosynthesis found in skin biopsy samples in these patients is also present in their mitral valve tissue this may predispose them to prolapse of the valve.
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36
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van der Bel-Kahn J, Duren DR, Becker AE. Isolated mitral valve prolapse: chordal architecture as an anatomic basis in older patients. J Am Coll Cardiol 1985; 5:1335-40. [PMID: 3998315 DOI: 10.1016/s0735-1097(85)80345-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Ten patients with an average age of 58 years underwent valve replacement because of isolated mitral valve prolapse with severe regurgitation. None had clinical evidence of Marfan's syndrome or another systemic disease that would indicate that a primary connective tissue disorder was the cause of the prolapse. All 10 patients had a dome configuration of the posterior leaflet and one or more ruptured chordae related to it. The gross morphology of the resected specimens revealed marked deviations in chordal branching and the pattern of anchoring in each of the 10 cases, rendering the most severely affected parts of the leaflets less well supported. Similar changes occurred at sites remote from the principal abnormality. Microscopically, the dominant tissue change was myxomatous transformation within the affected leaflets and chordae with secondary changes at both atrial and ventricular surfaces. These findings could indicate that insufficient chordal support may have promoted the development of the floppy valve through a process of chronic undue and unbalanced stress on the valve tension and closure apparatus. The resultant degeneration of the connective tissues, histologically expressed as myxomatous transformation, may underlie stretching and thus redundance of the leaflets and eventually rupture of chordae. It is suggested that this sequence of events be considered as a possible pathogenetic mechanism of isolated mitral valve prolapse, particularly in the subset of aged patients.
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37
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Lippman SM, Abergel RP, Ginzton LE, Uitto J, Tanaka KR, Miyamoto EK, Laks MM. Mitral valve prolapse in sickle cell disease: manifestation of a generalized connective tissue disorder. Am J Hematol 1985; 19:1-12. [PMID: 3985003 DOI: 10.1002/ajh.2830190102] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Previous studies have shown an association of sickle cell disease with generalized connective tissue disorders such as pseudoxanthoma elasticum. We recently documented an unexpectedly high prevalence of mitral valve prolapse, a connective tissue disorder, in sickle cell disease. To investigate this association, skin biopsies were analyzed from 32 sickle cell disease patients, 11 of whom had mitral prolapse. Total and type III collagen, collagen solubility, and uronic acid were not different between the patients with or without mitral prolapse (p greater than 0.05). Computerized morphometric quantitation of the volume fraction of elastic fibers was greater in sickle cell disease patients than in 10 normals (3.1 +/- 0.1 mean +/- SEM vs 2.0 +/- 0.3%; p less than 0.01) but less than in three patients with pseudoxanthoma elasticum (9.7 +/- 0.6%; p less than 0.001). Desmosine radioimmunoassay (an index of elastic fibers) was greater in sickle cell disease patients with mitral prolapse than those without (239.3 +/- 9.3 vs 171.7 +/- 25.4 ng/mg wet weight; p less than 0.02). Histopathologic grading showed a similar trend (p = 0.07). The combined probabilities of these three independent tests of elastic fiber quantity showed an increased elastic fiber concentration in mitral prolapse patients compared to those without mitral prolapse (p less than 0.02). Thus, there is no evidence for a specific collagen defect; rather, sickle cell disease appears to be associated with a spectrum of elastic tissue disorders, a feature that could predispose to mitral valve prolapse.
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38
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Malcolm AD. Mitral valve prolapse associated with other disorders. Casual coincidence, common link, or fundamental genetic disturbance? Heart 1985; 53:353-62. [PMID: 3885977 PMCID: PMC481772 DOI: 10.1136/hrt.53.4.353] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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39
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Lakier JB, Copans H, Rosman HS, Lam R, Fine G, Khaja F, Goldstein S. Idiopathic degeneration of the aortic valve: a common cause of isolated aortic regurgitation. J Am Coll Cardiol 1985; 5:347-57. [PMID: 3968318 DOI: 10.1016/s0735-1097(85)80057-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
To establish the etiology of isolated aortic valvular regurgitation, histologic examination was carried out on 27 consecutive surgically removed aortic valves from patients with aortic regurgitation. In 12 patients, the regurgitation was due to rheumatic or syphilitic valvular disease or a congenital bicuspid aortic valve. In the remaining 15, no etiology was apparent. In the latter group, seven aortic valves were identified by the surgeon as redundant and eight as thickened and retracted. Despite these gross differences, the histologic features of the 15 valves were similar and consisted of increased and disorganized elastic and collagen fibers, with variable quantities of acid mucopolysaccharide and calcium. Although small foci of myxomatous stroma were present, they did not differ substantially from those observed in age-matched competent aortic valves removed at necropsy, nor were they as extensive as described in reports of floppy aortic valves. Idiopathic degeneration was the most common cause of aortic regurgitation, occurring in more than half of the surgically treated patients. An underlying defect in the synthesis of collagen or elastic fibers, similar to that described in mitral valve prolapse, may be an important feature in aortic valve degeneration.
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40
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Abstract
To determine the causes of ruptured chordae tendineae and a suspected etiologic role for mitral valve prolapse (MVP), the mitral valve in 25 consecutive and surgically proved cases of chordal rupture were examined. The diagnosis of MVP was made on the basis of redundancy and marked hooding of the mitral leaflets and on histologic changes. MVP was the underlying morphologic abnormality in 23 patients, only 1 of whom had infective endocarditis that was responsible for the rupture. Thus MVP was the only underlying morphologic abnormality in 22 of 25 patients (88%). Another finding in this study was the demonstration of auscultatory and angiographic or echocardiographic evidence of MVP in 4 patients, aged 4 to 11 years (mean 7), before chordal rupture; no patient had had endocarditis. The morphologic and historical evidence would indicate that MVP is probably the most common cause of so-called spontaneous chordal rupture.
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41
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Abstract
The clinical manifestations of Ehlers-Danlos syndrome have been discussed. These include oral symptoms and problems with the integument, joints, and vasculature. An outline of the variations in the types of Ehlers-Danlos syndrome was given. The expected tissue response to tooth movement was discussed. Finally, a report of the orthodontic treatment of a patient with Ehlers-Danlos syndrome with its special clinical considerations was provided.
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42
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Chan D, Cole WG. Quantitation of type I and III collagens using electrophoresis of alpha chains and cyanogen bromide peptides. Anal Biochem 1984; 139:322-8. [PMID: 6476370 DOI: 10.1016/0003-2697(84)90012-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The methods of quantitating the relative amounts of type I and III collagens in samples containing crosslinked collagen chains were evaluated using electrophoresis of alpha chains and cyanogen bromide peptides. The densitometry areas of the alpha I(I) chains from type I collagen and the alpha I(III) chains from type III collagen were reduced because of the failure of the crosslinked chains to dissociate. However, the ratios of the unit densitometry areas of these chains (area of chain/micrograms type I or III collagen loaded) were constant for type I and III collagens prepared from the same samples of tissue. A calibration factor, which was the same for dermis and mitral valve, was derived to convert the densitometry area ratios to the weight ratios of type I to III collagens. In contrast, the densitometry areas of the alpha I(I) CB8 (type I collagen marker) and the alpha I(III) CB5 (type III collagen marker) were not reduced by crosslinked collagen chains. A calibration factor was also derived to convert the ratios of the densitometry areas of the marker peptides to weight ratios of type I to type III collagens. Almost identical results were obtained when electrophoresis of alpha chains and of cyanogen bromide peptides was used with these calibration factors to quantitate the relative amounts of type I and III collagens in tissue extracts which contained different amounts of crosslinked chains.
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Cole WG, Chan D, Hickey AJ, Wilcken DE. Collagen composition of normal and myxomatous human mitral heart valves. Biochem J 1984; 219:451-60. [PMID: 6430269 PMCID: PMC1153502 DOI: 10.1042/bj2190451] [Citation(s) in RCA: 118] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The collagens were studied in 13 normal and 19 myxomatous human mitral valves. The collagens of the valve were completely solubilized by using a method consisting of guanidinium chloride extraction, limited pepsin digestions and CNBr cleavage of the residue. The normal valves contained 74% type I, 24% type III and 2% type V collagen. The type I and type III collagens had similar solubility patterns, although only type I collagen was detected in the guanidinium chloride extract. Type V collagen was only detected in the first pepsin extract. The type I and III collagens had higher contents of hydroxylysine than did the same collagens from age-matched dermis. The two-dimensional electrophoretic 'maps' of CNBr-cleavage peptides showed low recoveries of the C-terminal alpha 1(I) CB6 and alpha 1(III) CB9 peptides, which are involved in forming intermolecular cross-linkages. Most of the reducible cross-linkages were present in large-Mr peptide complexes, and these complexes were shown by labelling with 125I to include the tyrosine-containing alpha 1(I) CB6 peptide. The myxomatous valves contained 67% type I, 31% type III and 2% type V collagens. There was a significant increase in the concentration of each type of collagen, which consisted of a 9% increase of type I collagen, a 53% increase of type III collagen and a 25% increase of type V collagen. The contents of hydroxylysine in type I and III collagens and the electrophoretic 'maps' of the CNBr-cleavage peptides involved in cross-linkages did not differ significantly from the results obtained from the normal valves. The biochemical findings suggest that there is an increased production of collagen, in particular type III collagen, and glycosaminoglycan as well as a proliferation of cells as part of a repair process in the myxomatous valves.
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Kramer-Fox R, Devereux RB, Brown WT, Hartman N, Elston RC. Lack of association between dermal arches and mitral valve prolapse: relation to anxiety. Am J Cardiol 1984; 53:148-52. [PMID: 6691251 DOI: 10.1016/0002-9149(84)90699-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Mitral valve prolapse (MVP) has been reported to be associated with an increased frequency of dermal arches. To determine whether dermal arches are associated with MVP, 42 patients with echocardiographic (echo) MVP (probands) and 140 first-degree relatives in their families, including 48 with and 92 without MVP, were studied. Seventy-five, subjects with neither MVP nor blood relation to probands served as control subjects. Among the female probands, 6.9% had arches and among the males, 3.8% had arches. The proportion of arches was lower among female control subjects (4.0%) but higher among male control subjects (7.9%) (neither difference being significant [NS]). Among the relatives, 7.1% of the women with MPV and 4.6% of the women without MVP had arches (NS). Five percent of the men with MVP and 6.3% without MVP had arches (NS). No association existed between the occurrence of cardiovascular symptoms in patients and family members with MVP and presence of dermal arches, but a high proportion of probands with elevated trait anxiety without panic disorder had 4 or more dermal arches. These findings do not support a direct association of dermal arches with MVP.
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Abstract
To investigate the prevalence of cardiac abnormalities in osteogenesis imperfecta we performed a clinical and echocardiographic study on 20 patients. One patient had aortic regurgitation, 13 had soft late apical systolic murmurs (without significant mitral regurgitation), and seven had systemic hypertension. In only one patient was there echocardiographic evidence of mitral valve prolapse. The aortic root diameter exceeded the normal range in six patients, two of whom were hypertensive. The overall mean value (+/- 1 S.D.) in the 16 patients without marked skeletal deformity was 2.02 +/- 0.33 cm/m2. The echocardiographic appearances suggested that the left-sided valve cusps were thin, and in 13 patients the aortic valve leaflets showed a coarse systolic flutter.
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Macieira-Coelho E, Pais F, Monteiro F, da Conceição JM, Alves MG, Pereira L. Barlow's syndrome associated with coronary fistula. Angiology 1983; 34:688-92. [PMID: 6625224 DOI: 10.1177/000331978303401007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In an asymptomatic patient, the first reference to the association of mitral valve prolapse and coronary fistula is described and a pathogenic connection discussed.
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Pyeritz RE, Wappel MA. Mitral valve dysfunction in the Marfan syndrome. Clinical and echocardiographic study of prevalence and natural history. Am J Med 1983; 74:797-807. [PMID: 6837604 DOI: 10.1016/0002-9343(83)91070-7] [Citation(s) in RCA: 130] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Although mitral regurgitation and fibromyxomatous thickening of the mitral leaflets have long been recognized as such, mitral valve prolapse has only recently been added as one of the pleiotropic features of the Marfan syndrome. The prevalence, age of onset, and natural history of mitral valve dysfunction in this condition are uncertain. Therefore, all patients in one clinic who met strict diagnostic criteria for the Marfan syndrome and who had clinical and echocardiographic examinations before age 22 years were reviewed. Of the 166 patients (84 males, aged 11.9 +/- 0.6 years [mean +/- SEM]; and 82 females, 11.0 +/- 0.6 years), 52 percent had auscultatory and 68 percent had echocardiographic evidence of mitral valve dysfunction, generally mitral valve prolapse. Prevalence did not differ between the sexes. Follow-up in 115 patients averaged five examinations over a mean of four years; 17 percent were followed for more than six years. Criteria for progression of mitral valve dysfunction were: (1) on auscultation, the appearance of new systolic clicks or apical systolic murmurs, a mitral regurgitant murmur increased by two grades, or appearance of congestive heart failure not due to aortic regurgitation; and (2) on echocardiography, the new appearance of mitral valve prolapse or abnormally increased left atrial dimension. Nearly half the patients met at least one criterion and one quarter had both auscultatory and echocardiographic evidence of progressive mitral valve dysfunction. Twice as many females demonstrated worse mitral valve function with time. Eight of the 166 patients either died as a result of mitral valve dysfunction or required mitral valve replacement. Severe mitral regurgitation developed in an additional 15 patients. Rupture of chordae tendineae was uncommon. Antibiotic prophylaxis was routine, and no cases of bacterial endocarditis of the mitral valve occurred. These results suggest that mitral valve dysfunction is extremely common in young patients with Marfan syndrome and usually presents as mitral valve prolapse. Serious mitral regurgitation develops in one of every eight patients by the third decade. Thus, the prevalence and natural history of mitral valve prolapse in the Marfan syndrome appear distinct from mitral valve prolapse associated with other conditions, including idiopathic or familial mitral valve prolapse.
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Last JA, Siefkin AD, Reiser KM. Type I collagen content is increased in lungs of patients with adult respiratory distress syndrome. Thorax 1983; 38:364-8. [PMID: 6879485 PMCID: PMC459559 DOI: 10.1136/thx.38.5.364] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Collagen in lung tissue was examined from patients with adult respiratory distress syndrome, from patients who did not have this disease but required mechanical ventilation and oxygen treatment, and from patients without overt lung disease. Cyanogen bromide peptide mapping techniques were used to determine the ratio of type I to type III collagen present in these lungs. In the fibrotic lungs from patients with adult respiratory distress syndrome a shift was found in the ratio of type I to type III from the normal value of 2:1 to a mean value of 3.4:1. In patients with normal lungs and those with other lung diseases collagen type ratios were normal. Our data suggest that (i) changes in lung collagen of patients with adult respiratory distress syndrome resemble those previously described in patients with idiopathic pulmonary fibrosis, although the changes occur much more rapidly in the former; (ii) the increased content of collagen in lungs of patients with adult respiratory distress syndrome shown by others is predominantly of type I collagen; and (iii) the stimulus to the lung to produce excess type I collagen relative to type III is not solely of iatrogenic origin--that is, resulting from oxygen or ventilator treatment.
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Abstract
The relationship between relative mobility on sodium dodecyl sulfate-polyacrylamide gels and the logarithm of molecular weight was linear for peptides derived by CNBr cleavage from purified collagen chains. One striking exception was found: when the CNBr peptide alpha 1(III)CB-8 was subjected to electrophoresis on a polyacrylamide slab gel calibrated with other peptides derived from the type III collagen chain, its relative mobility corresponded to a molecular weight of approximately 8,000. On a gel calibrated with globular proteins, its apparent molecular weight was 12,000. Its actual molecular weight, as determined by gel filtration and by amino acid analysis, is approximately 12,000. The dodecyl sulfate-protein binding ratio for this peptide did not differ from that of other collagenous peptides or globular proteins. Free electrophoretic mobilities and retardation coefficients were determined for selected collagenous peptides and globular proteins by electrophoresis on tube gels of different concentrations of acrylamide. By these indices, alpha 1(III)CB-8 resembled a globular protein rather than a collagenous peptide. Presumably, some difference in primary structure of this peptide results in conformational changes of its complex with dodecyl sulfate, such that the peptide-dodecyl sulfate complex behaves more like a globular protein than a collagenous peptide on polyacrylamide gels.
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Type V collagen. Quantitation in normal lungs and in lungs of rats with bleomycin-induced pulmonary fibrosis. J Biol Chem 1983. [DOI: 10.1016/s0021-9258(18)33252-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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