DOCSLIB.ORG

Lymphatic Metastasis in the Mitral Valve W

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Lymphatic Metastasis in the Mitral Valve W Br Heart J: first published as 10.1136/hrt.39.2.218 on 1 February 1977. Downloaded from Case reports British Heart Journal, 1976, 38, 218-221 Lymphatic metastasis in the mitral valve W. E. MORGAN AND P. B. GRAY From the Department of Cardio-Thoracic Surgery and Department of Morbid Anatomy, Northern General Hospital, Sheffield The case is reported of a 45-year-old woman with a metastatic tumour within the mitral valve. Involvement of the heart by metastatic neoplasm At operation the heart showed only the changes is not uncommon. Postmortem studies of patients associated with mitral stenosis. Open exploration with malignant disease show that cardiac involve- of the mitral valve showed thickening and calci- ment occurs in up to 21 per cent of cases (Bisel, fication of both cusps, with fibrosis and shortening Wr6blewski, and LaDue, 1953). The pericardium, of the subvalvular mechanism. The valve was epicardium, and myocardium are the areas of the replaced by a Bjork-Shiley prosthesis. heart most commonly involved by secondary Histological studies were done of the excised tumour; spread to the endocardium and heart valve: routine paraffin sections were prepared from valves is rare (Coller, Inkley, and Moragues, 1950). the formalin fixed specimen and stained with hae- We report a case of secondary tumour spread into matoxylin and eosin and Machiavello's and the the substance of the mitral valve; this was a chance phloxine tartrazine method for inclusion bodies as finding on histological examination of a surgically part of a separate study being conducted into the http://heart.bmj.com/ removed rheumatic valve. association of psittacosis and valvular disease. The valve showed fibrotic thickening with a Case report moderate degree of calcification and several areas A 45-year-old woman presented with the features of myxoid connective tissue in which were dilated of mitral valve stenosis. She had had rheumatic small blood vessels and endothelium lined spaces fever in childhood and developed progressive resembling lymphatics. There were no vegetations dyspnoea in her mid-30s. A closed mitral valvotomy and no bacterial involvement. There were two small at the age of 39 resulted in conspicuous sympto- clumps of neoplastic cells lying within the 'lym- on September 28, 2021 by guest. Protected copyright. matic improvement. She remained well for 5 years phatics', which were present only in two successive when increasing dyspnoea, tiredness, and weight sections at one level, which had been stained by loss made her seek medical advice. the phloxine tartrazine and Machiavello's methods. On examination she was thin and had a malar Numerous further sections were cut but no more flush. The pulse was 70 per minute and regular. tumour was found. Her blood pressure was 130/70 mmHg. There were The tumour cells showed considerable nuclear clinical signs of right ventricular hypertrophy and pleomorphism and a high nuclear/cytoplasmic mitral stenosis. Chest, abdomen, and central ratio. There was no apparent mucin or pigment nervous system were normal to clinical examination. production and a diagnosis was made simply of Laboratory investigations showed a normal blood 'poorly differentiated carcinoma'. No attempt was picture and liver function. A chest x-ray film showed made to restain either of the positive sections. an enlarged left atrium with upper lobe venous The possibility that these deposits were 'floaters' diversion. The electrocardiogram showed evidence was excluded by a careful check on the other speci- of right ventricular hypertrophy. An echogram mens cut up and processed at the same time, in revealed a stenosed, thickened mitral valve. The none of which was a similar carcinoma processed. diagnosis was mitral stenosis with a dilated left Moreover, the appearance of the deposits in two atrium and hypertrophied right ventricle and a successive sections is not characteristic of an arte- further operation was advised. fact (Fig. 1 and 2). 218 Br Heart J: first published as 10.1136/hrt.39.2.218 on 1 February 1977. Downloaded from Lymphatic metastasis in the mitral valve 219 FIG. 1 One of the two fragments of tumour, lying withina ? lymphatic. (Machiavello's stain. x 260.) http://heart.bmj.com/ on September 28, 2021 by guest. Protected copyright. FIG. 2 Higher power view of the other fragment. (Machiavello's stain. x 640.) Br Heart J: first published as 10.1136/hrt.39.2.218 on 1 February 1977. Downloaded from 220 Morgan and Gray Further clinical examination and investigations Leak and Burke (1966) described the electron failed to reveal a primary tumour or any other microscopical features of amphibian and mamma- secondary deposits. Of the tumours known to lian lymphatics, which have neither basement metastasize from occult primary sites, oat cell membrane nor condensed connective tissue support carcinoma, melanoma, breast, and thyroid tumours but were recognizable by the presence of 'half were considered most likely. We did not think the desmosomes'-fibrillary structures appearing to histological appearance of the deposits gave any anchor the endothelium directly to the surrounding definite indication of the primary source. connective tissue. Bradham, Parker, and Greene The patient made a good postoperative recovery (1973) using these criteria demonstrated lymphatics and was allowed home two weeks after operation. in canine atrioventricular valves with electron She is being followed up in the out-patient clinic microscopy. and appears to be making good progress. Studies in human valves have met with less success. Eberth and Belajeff reported lymphatics Discussion in human cardiac valves in 1866. Johnson and The antemortem histological diagnosis of meta- Blake (1966) also reported lymphatics in two static spread to a cardiac valve has not been pre- human mitral valves. viously described. The antemortem diagnoses of Reading the papers cited leads us to believe that cardiac metastases have been mainly presumptive lymphatics are present in animal and human diagnoses in patients with known malignant disease atrioventricular valves mainly on the atrial surface who develop disorders of cardiac performance and and that their number and appearance may vary non-specific electrocardiographic abnormalities with disease and age. (Goudie, 1955). Positive histology has been reported In our case we found tumour in thin-walled in patients with malignant pericardial effusions. endothelial tubes without connective tissue support Improvement in cardiac performance has resulted or a clear basement membrane. This, coupled with from irradiation of hearts involved by malignant the less reliable criterion of a complete lack of disease (Hanfling, 1960); and it may be that radio- blood cells in numerous sections at different levels, therapy will be of use in our patient should she led us to believe that these channels were lympha- develop a cardiac dysfunction which does not tics. respond to conventional treatment. We have noticed numerous and varied vascular The previous reports of secondary spread to channels in many diseased valves removed surgi- http://heart.bmj.com/ cardiac valves were of postmortem cases and cally but have not yet had the opportunity of showed either direct implantation of tumour subjecting them to electron microscopy. on to valve endothelium or infiltration into the Kline (1972) thought that lymphatics were an valve from neighbouring myocardial deposits important pathway for secondary tumour spread (Hanfling, 1960). Clancy and Roberts (1968) to the heart. He found the mediastinal lymph reported 2 examples of tricuspid valves involved by nodes were almost always involved by tumour and malignant melanoma and Roberts, Clency, and subsequent retrograde lymphatic spread of tumour DeVita (1968) reported one tricuspid valve involved to the heart resulted in lymphatic obstruction. The on September 28, 2021 by guest. Protected copyright. by lymphoma, but the exact mode of involvement appearance of secondary tumour in dilated lym- was not specified. phatics which he described resembles the picture The case described here was one of secondary in our case. He did not, however, describe valve spread into an endothelium-lined space within a involvement. mitral valve and we think that this vessel was a The effect of obstruction to the cardiac lympha- valve lymphatic. However, while the existence of tics has been studied in animals (Ullal, Kluge, and lymphatics in animal atrioventricular valves has Gerbode, 1972a; Miller, Pick, and Katz, 1963). been clearly shown, evidence for their existence in Impairment of myocardial function has been human valves is not yet so convincing. noted. Increased fibrosis in the endocardium has Miller, Pick, and Katz (1961) injected India been reported. Fibrosis and myxomatous changes ink suspension into the atrioventricular valves of in the atrioventricular valves of dogs has followed beating canine hearts and then subjected the ligation of the cardiac lymphatics. valves to routine light microscopy. They described The place of lymphatic obstruction in human carbon particles within thin-walled endothelium- cardiac disease is conjectural. It has been suggested lined channels with little surrounding connective as a cause of myocardial damage in rheumatic tissue. Other workers using India ink, dye, or carditis. Myxomatous degeneration of the mitral hydrogen peroxide have reported similar findings valve and endocardial fibrosis have also been (Johnson and Blake, 1966; Ullal et al., 1972b). linked with lymphatic obstruction. Br Heart J: first published as 10.1136/hrt.39.2.218 on 1 February 1977. Downloaded from Lymphatic metastasis in the mitral valve 221 It is possible that lymphatic obstruction contri- Johnson, R. A., and Blake, T. M. (1966). Lymphatics of the heart. Circulation, 33, 137. buted (to a minor degree) to the fibrosis seen in this Kline, I. K. (1972). Cardiac lymphatic involvement by meta- patient's mitral valve. static tumour. Cancer (Philadelphia), 29, 799. Leak, L. V., and Burke, J. F. (1966). Fine structure of the We thank Mr. G. H. Smith and Dr. A. J. N. Warrack for lymphatic capillary and the adjoining connective tissue their help in preparing this report.
Load more

Recommended publications
  • Blood Flow DHO8 7.8, Pg
    Blood Flow DHO8 7.8, pg. 190 HS1/2017-2018 Circuits •Pulmonary circuit –The blood pathway between the right of the heart, to the lungs, and back to the left side of the heart. •Systemic circuit –The pathway between the left side of the heart, to the body, and back to the right side of the heart. The Pathway of Blood •Superior & Inferior Vena •Left Atrium Cava •Mitral Valve •Right Atrium •Left Ventricle •Tricuspid Valve •Aortic Semilunar Valve •Right Ventricle •Aorta •Pulmonary Semilunar -Arteries Valve -Arterioles •Pulmonary Artery -Capillaries •Lungs -Venules –Pulmonary Arterioles -Veins –Pulmonary Capillaries –Pulmonary Venules •Pulmonary Vein Blood Flow Through Heart Do You Know? • When blood leaves the left atrium, where does it go next? a) Aorta b) Left ventricle c) Right atrium d) Pulmonary artery And the answer is….A Do You Know? • After blood leaves the right atrium, what valve prevents the back flow? a) Pulmonary b) Mitral c) Tricuspid d) Aortic And the answer is…C Do You Know? • The right ventricle is the chamber of the heart that pumps blood for the pulmonary circulation. Based on this information, blood from the right ventricle is on its way to the _____. a) Liver b) Lungs c) Hands and feet And the answer is…B Do You Know? • Which of the following is correct order of blood flow for the right side of the heart? a) RA, Tricuspid valve, RV, PSLV, pulmonary artery b) RA, PSLV, RV, Tricuspid valve, pulmonary artery c) RA, Tricuspid valve, RV, pulmonary artery , PSLV And the answer is…A Do You Know? • Which of the following is correct order of blood flow for the left side of the heart? a) LA, Bicuspid valve, LV, ASLV, aorta b) LA, ASLV, LV, Bicuspid valve, aorta c) LA, Bicuspid valve, LV, ASLV, aorta And the answer is…C.
    [Show full text]
  • Mitral Valve Prolapse, Arrhythmias, and Sudden Cardiac Death: the Role of Multimodality Imaging to Detect High-Risk Features
    diagnostics Review Mitral Valve Prolapse, Arrhythmias, and Sudden Cardiac Death: The Role of Multimodality Imaging to Detect High-Risk Features Anna Giulia Pavon 1,2,*, Pierre Monney 1,2,3 and Juerg Schwitter 1,2,3 1 Cardiac MR Center (CRMC), Lausanne University Hospital (CHUV), 1100 Lausanne, Switzerland; [email protected] (P.M.); [email protected] (J.S.) 2 Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), 1100 Lausanne, Switzerland 3 Faculty of Biology and Medicine, University of Lausanne (UniL), 1100 Lausanne, Switzerland * Correspondence: [email protected]; Tel.: +41-775-566-983 Abstract: Mitral valve prolapse (MVP) was first described in the 1960s, and it is usually a benign condition. However, a subtype of patients are known to have a higher incidence of ventricular arrhythmias and sudden cardiac death, the so called “arrhythmic MVP.” In recent years, several studies have been published to identify the most important clinical features to distinguish the benign form from the potentially lethal one in order to personalize patient’s treatment and follow-up. In this review, we specifically focused on red flags for increased arrhythmic risk to whom the cardiologist must be aware of while performing a cardiovascular imaging evaluation in patients with MVP. Keywords: mitral valve prolapse; arrhythmias; cardiovascular magnetic resonance Citation: Pavon, A.G.; Monney, P.; Schwitter, J. Mitral Valve Prolapse, Arrhythmias, and Sudden Cardiac Death: The Role of Multimodality 1. Mitral Valve and Arrhythmias: A Long Story Short Imaging to Detect High-Risk Features. In the recent years, the scientific community has begun to pay increasing attention Diagnostics 2021, 11, 683.
    [Show full text]
  • Chapter 12 the Cardiovascular System: the Heart Pages
    CHAPTER 12 THE CARDIOVASCULAR SYSTEM: THE HEART PAGES 388 - 411 LOCATION & GENERAL FEATURES OF THE HEART TWO CIRCUIT CIRCULATORY SYSTEM DIVISIONS OF THE HEART FOUR CHAMBERS Right Atrium Left Atrium Receives blood from Receives blood from the systemic circuit the pulmonary circuit FOUR CHAMBERS Right Ventricle Left Ventricle Ejects blood into the Ejects blood into the pulmonary circuit systemic circuit FOUR VALVES –ATRIOVENTRICULAR VALVES Right Atrioventricular Left Atrioventricular Valve (AV) Valve (AV) Tricuspid Valve Bicuspid Valve and Mitral Valve FOUR VALVES –SEMILUNAR VALVES Pulmonary valve Aortic Valve Guards entrance to Guards entrance to the pulmonary trunk the aorta FLOW OF BLOOD MAJOR VEINS AND ARTERIES AROUND THE HEART • Arteries carry blood AWAY from the heart • Veins allow blood to VISIT the heart MAJOR VEINS AND ARTERIES ON THE HEART Coronary Circulation – Supplies blood to the muscle tissue of the heart ARTERIES Elastic artery: Large, resilient vessels. pulmonary trunk and aorta Muscular artery: Medium-sized arteries. They distribute blood to skeletal muscles and internal organs. external carotid artery of the neck Arteriole: Smallest of arteries. Lead into capillaries VEINS Large veins: Largest of the veins. Superior and Inferior Vena Cava Medium-sized veins: Medium sized veins. Pulmonary veins Venules: the smallest type of vein. Lead into capillaries CAPILLARIES Exchange of molecules between blood and interstitial fluid. FLOW OF BLOOD THROUGH HEART TISSUES OF THE HEART THE HEART WALL Pericardium Outermost layer Serous membrane Myocardium Middle layer Thick muscle layer Endocardium Inner lining of pumping chambers Continuous with endothelium CARDIAC MUSCLE Depend on oxygen to obtain energy Abundant in mitochondria In contact with several other cardiac muscles Intercalated disks – interlocking membranes of adjacent cells Desmosomes Gap junctions CONNECTIVE TISSUE Wrap around each cardiac muscle cell and tie together adjacent cells.
    [Show full text]
  • Heart Valve Disease: Mitral and Tricuspid Valves
    Heart Valve Disease: Mitral and Tricuspid Valves Heart anatomy The heart has two sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. The left side of the heart receives the oxygen- rich blood from the lungs and pumps it to the body. The heart has four chambers and four valves that regulate blood flow. The upper chambers are called the left and right atria, and the lower chambers are called the left and right ventricles. The mitral valve is located on the left side of the heart, between the left atrium and the left ventricle. This valve has two leaflets that allow blood to flow from the lungs to the heart. The tricuspid valve is located on the right side of the heart, between the right atrium and the right ventricle. This valve has three leaflets and its function is to Cardiac Surgery-MATRIx Program -1- prevent blood from leaking back into the right atrium. What is heart valve disease? In heart valve disease, one or more of the valves in your heart does not open or close properly. Heart valve problems may include: • Regurgitation (also called insufficiency)- In this condition, the valve leaflets don't close properly, causing blood to leak backward in your heart. • Stenosis- In valve stenosis, your valve leaflets become thick or stiff, and do not open wide enough. This reduces blood flow through the valve. Blausen.com staff-Own work, CC BY 3.0 Mitral valve disease The most common problems affecting the mitral valve are the inability for the valve to completely open (stenosis) or close (regurgitation).
    [Show full text]
  • Heart and Circulatory System Heart Chambers
    160 Allen Street Rutland, Vermont 05701 www.rrmc.org 802.775.7111 Anatomy of the Heart Overview The heart is a muscular organ that pumps blood HEART AND throughout your body. It is positioned behind the CIRCULATORY SYSTEM lungs, slightly to the left side of the chest. Your heart is a bit larger than the size of your fist. Let's examine the structures of the heart and learn how blood travels through this complex organ. Right Side The heart is divided into two sides and four chambers. On the right side, blood that has already circulated through the body enters the heart through the superior vena cava and the inferior vena cava. The blood flows into the right atrium. When this chamber is full, the heart pushes the blood through the tricuspid valve and into the the next chamber - the right ventricle. From there, the blood is pushed out of the heart through the pulmonary valve. The blood travels through the pulmonary artery to the lungs, where it will pick up oxygen and give up carbon dioxide. HEART CHAMBERS Left Side On the left side of the heart, blood that has received oxygen from the lungs enters the heart through the pulmonary veins. The blood flows into the left atrium. It is pushed through the mitral valve into the left ventricle. Finally, it is pushed through the aortic valve and into the aorta. The aorta is the body's largest artery. It helps distribute the oxygen-rich Right Left blood throughout the body. Valves Now let's take a closer look at the valves.
    [Show full text]
  • Selecting Candidates for Transcatheter Mitral Valve Repair
    • INNOVATIONS Key Points Selecting Candidates for • Mitral valve regurgitation, or leaky mitral valve, is a common valve disorder Transcatheter Mitral Valve Repair in which the leaflets of the mitral valve fail to seal effectively, resulting in Annapoorna S. Kini, MD Samin K. Sharma, MD some blood flowing back in the left atrium every time Mitral valve regurgitation is a common valve disorder The EVEREST (Endovascular Valve Edge-to- the left ventricle contracts. that causes blood to leak backward through the Edge Repair Study) II Trial was a randomized study This condition has been mitral valve and into the left atrium as the heart comparing the transcatheter approach using traditionally addressed muscle contracts. Mitral regurgitation can originate MitraClip®—a tiny cobalt chromium clip that sutures with open heart surgery. from degenerative or structural defects due to the anterior and posterior mitral valve leaflets—with aging, infection, or congenital anomalies. In contrast, surgery in patients with moderate to severe mitral • We use the latest imaging functional mitral regurgitation occurs when coronary regurgitation who are candidates for either procedure. techniques both to ensure artery disease or events such as a heart attack change that each patient is a good After five years, the study has demonstrated that the size and shape of the heart muscle, preventing candidate for the procedure, MitraClip was associated with a similar risk of death the mitral valve from opening and closing properly. In and to monitor their progress compared with mitral valve surgery after excluding people with moderate to severe mitral regurgitation, once the device is implanted. patients who required surgery within six months.
    [Show full text]
  • Ventricular Anatomy for the Electrophysiologist (Part
    Ventricular Anatomy for the REVIEW Electrophysiologist (Part II) SPECIAL 서울대학교 의과대학 병리학교실 서정욱 이화여자대학교 의학전문대학원 김문영 ABSTRACT The conduction fibers and Purkinje network of the ventricular myocardium have their peculiar location and immuno-histochemical characteristics. The bundle of His is located at the inferior border of the membranous septum, where the single trunk ramifies into the left and right bundle branches. The left bundle branches are clearly visible at the surface. The right bundles are hidden in the septal myocardium and it is not easy to recognize them. The cellular characters of the conduction bundles are modified myocardial cells with less cytoplasmic filaments. Myoglobin is expressed at the contractile part, whereas CD56 is expressed at the intercalated disc. A fine meshwork of synaptophysin positive processes is noted particularly at the nodal tissue. C-kit positive cells are scattered, but their role is not well understood. Purkinje cells are a peripheral continuation of bundles seen at the immediate subendocardium of the left ventricle. Key words: ■ conduction system ■ Purkinje network ■ pathology ■ arrhythmia ■ electrophysiology Introduction human heart. In this brief review, the histological characteristics of conduction cells, stained by The functional assessment of abnormal cardiac conventional and immuno-histochemical staining, are 3 rhythm and a targeted treatment based on demonstrated in the second part of the review. electrophysiologic studies are successful advances in cardiology.1 Morphological assessment or confirmation The characteristic location of the ventricular of hearts with such abnormalities is rare, not only due conduction system to the limited availability of human hearts but also inherent technological limitations of existing The atrioventricular node is situated in its technology.2 Classical morphological approaches and subendocardial location at the triangle of Koch.
    [Show full text]
  • Mitral Valve Surgery with the Edwards Pericardial Mitral Bioprosthesis
    Mitral Valve Surgery With the Edwards Pericardial Mitral Bioprosthesis What You and Your Loved Ones Should Know Introduction This guide is for patients who have mitral heart valve disease and whose doctors have proposed surgery to replace the valve. It will help you and your loved ones learn more about your heart and how it works. You will also learn about valve disease and surgery options. Be sure to ask your doctor to explain the treatment choices and the heart valves used for surgery. This booklet does not include everything you need to know about heart valves, heart valve replacement surgery, or about related medical care. Regular check-ups by your heart doctor are important. Call or see your doctor whenever you have questions or concerns about your health, especially if you have any unusual symptoms or changes in your overall health. Table of Contents How does your heart work?....................................................................................................................XX What is mitral valve disease?..................................................................................................................XX How is mitral valve disease treated?.......................................................................................................XX What are your treatment options?..........................................................................................................XX What are your surgical mitral valve options?..........................................................................................XX
    [Show full text]
  • Heart – Inflammation
    Heart – Inflammation 1 Heart – Inflammation Figure Legend: Figure 1 Heart, Valve - Inflammation, Acute in a female F344/N rat from a chronic study. Neutrophils (arrows) are present within a valve. Figure 2 Heart, Valve - Inflammation, Suppurative in a female F344/N rat from a chronic study. Suppurative inflammation is present in the mitral valve (arrows). Figure 3 Heart, Valve - Inflammation, Suppurative in a female F344/N rat from a chronic study (higher magnification of Figure 2). Suppurative inflammation of the mitral valve has aggregates of bacteria (arrows). Figure 4 Heart, Valve - Inflammation, Chronic in a female F344/N rat from a chronic study. Mixed inflammatory cells are present within the thickened mitral valve (arrows). Figure 5 Heart, Valve - Inflammation, Chronic in a female F344/N rat from a chronic study (higher magnification of Figure 4). Mixed inflammatory cells and proliferation of mesenchymal cells result in thickening of the mitral valve. Figure 6 Heart, Valve - Inflammation, Chronic in a female F344/N rat from a chronic study (higher magnification of Figure 4). Lymphocytes, macrophages, and plasma cells with proliferating mesenchymal cells are present in the mitral valve. Figure 7 Heart - Inflammation, Chronic-active in a male F2 generation CD1 mouse. Inflammation of the heart along the endocardium consists primarily of neutrophils and macrophages. Figure 8 Heart - Inflammation, Chronic-active in a male B6C3F1/N mouse from a chronic study. Chronic active inflammation is present along the epicardial surface of the heart. Comment: Inflammation in the heart may occur in the myocardium, endocardium, or epicardium or may be associated with the valves.
    [Show full text]
  • The Mitral Valve Prolapse Syndrome
    THE MITRAL VALVE PROLAPSE SYNDROME by Ferris J. Siber, M.D., Assoc. Meal. Director & Frank L Pitkin, M.D., Second Vice President & Medical Director New England Mutual One of us (F.J.S.), in an earlier edition of the Journal of (rather than late systoleS; and the absence of any other Insurance Medicine, (Volume X, No. 1, Pages 4-7, physical findings on examination. January-March, 1979), described those anatomic The ECG may be normal or show infero-lateral ST-T considerations and measurements that have proven changes, borderline prolonged QTinterval, to be useful in the non-invasive technique of suprventricular and ventricular arrhythmias, atrio- echocardiography. ventricular block and pre-excitation. This paper will discuss the application of ultra- In both groups of patients, echocardiography sonography to a specific cardiac disorder, the mitral demonstrates the prolapse of the anterior and/or valve prolapse syndrome, and discuss the posterior leaflets of the mitral valve. manifestations on echocardiography. Simultaneous recording of the phonocardiogram and Synonyms for this disorder include: Ballooning the echocardiogram show that the systolic click occurs posterior leaflet syndrome; prolapsed mitral-leaflet about 0.06 seconds after the onset of the posterior myocardiopathy; systolic murmur-click syndrome; prolapse of the leaflets with the murmur accom- syndrome of apical systolic click, late systolic murmur, panying the posterior displacement. and abnormal T-waves; Barlow’s syndrome; mitral balloning; the billowing posterior mitral leaflet syn- The conspicuous posterior displacement of the drome; mitral insufficiency due to myxomatous anterior and/or posterior leaflets of the mitral valve dur- formation; "floppy" valve syndrome. (This last ing ventricular systole does not occur in that individual designation is especially appropriate since the syn- presenting with a systolic click, but without a systolic drome is usually associated with myxomatous murmur.
    [Show full text]
  • Anatomy and Physiology of the Cardiovascular System
    Chapter © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 5 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Anatomy© Jonesand & Physiology Bartlett Learning, LLC of © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION the Cardiovascular System © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION OUTLINE Aortic arch: The second section of the aorta; it branches into Introduction the brachiocephalic trunk, left common carotid artery, and The Heart left subclavian artery. Structures of the Heart Aortic valve: Located at the base of the aorta, the aortic Conduction System© Jones & Bartlett Learning, LLCvalve has three cusps and opens© Jonesto allow blood & Bartlett to leave the Learning, LLC Functions of the HeartNOT FOR SALE OR DISTRIBUTIONleft ventricle during contraction.NOT FOR SALE OR DISTRIBUTION The Blood Vessels and Circulation Arteries: Elastic vessels able to carry blood away from the Blood Vessels heart under high pressure. Blood Pressure Arterioles: Subdivisions of arteries; they are thinner and have Blood Circulation muscles that are innervated by the sympathetic nervous Summary© Jones & Bartlett Learning, LLC system. © Jones & Bartlett Learning, LLC Atria: The upper chambers of the heart; they receive blood CriticalNOT Thinking FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Websites returning to the heart. Review Questions Atrioventricular node (AV node): A mass of specialized tissue located in the inferior interatrial septum beneath OBJECTIVES the endocardium; it provides the only normal conduction pathway between the atrial and ventricular syncytia.
    [Show full text]
  • Mitral Valve Regurgitation
    MITRAL VALVE REGURGITATION WHAT IS MITRAL VALVE REGURGITATION? The mitral valve is on the left side of the heart between the left upper chamber (atrium) and lower chamber (ventricle). The valve has two flaps called leaflets that normally close every time the ventricle squeezes to pump blood out of the heart. When the mitral valve doesn't close properly, some of the blood from the ventricle is forced back up (regurgitated) into the left atrium instead of flowing out to the rest of the body. The added workload on the heart and the increased blood pressure in the lungs eventually cause problems. HOW DOES IT OCCUR? Rheumatic fever can damage the mitral valve leaflets and cause scarring. The scars deform the leaflets so that they don't close properly, and regurgitation occurs. A condition called mitral valve prolapse can also cause mitral regurgitation. With mitral valve prolapse, one or both of the leaflets bulge (prolapse) into the left atrium. A small amount of mitral regurgitation (MR) is common with mitral valve prolapse. If one or more of the structures attaching the leaflets to the heart muscle breaks, the valve may leak. Heart attacks, diseases of the heart muscle, or other heart valve abnormalities may cause the whole heart to enlarge. The enlargement stretches the mitral valve ring and muscular attachments, pulling the valve leaflets apart. When the leaflets no longer meet, leaking of the mitral valve (MR) results. Over time, the added workload on the heart may cause congestive heart failure. Congestive heart failure occurs when the heart can't pump enough blood to keep the lungs or other body tissues from filling with fluid.
    [Show full text]