Displaying publications 41 - 56 of 56 in total

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  1. Fulltext A forgotten clinical sign making a comeback
    Chiam KH, A Hing CT, Low LL
    Med J Malaysia, 2014 Feb;69(1):40-1.
    PMID: 24814630 MyJurnal
    We report a case of Staphylococcus aureus infective endocarditis in a patient presenting with fever and rare cutaneous manifestations of Osler Nodes and Janeway Lesions. There had not been any distinct risk factors. His echocardiography subsequently revealed vegetation at the anterior mitral valve leaflet. As Staphylococcus aureus infective endocarditis is of utmost significance in morbidity and mortality, a sharp clinical acumen and follow up investigations is required alongside a prolonged course of antibiotics. Our patient was then started on intravenous cloxacillin for 28 days and gentamicin for 5 days to which he made good progress and recovery.
    Matched MeSH terms: Mitral Valve
  2. Tricuspid valve papillary fibroelastoma: a rare tumor with a diagnostic dilemma
    Haron H, Yusof MR, Maskon O, Ooi J, Rahman MR
    Heart Surg Forum, 2012 Feb;15(1):E59-60.
    PMID: 22360910 DOI: 10.1532/HSF98.20111000
    Papillary fibroelastoma is a rare primary tumor of the heart valves. This lesion can occur on any of the valves or endothelial surface of the heart and has been detected by echocardiography, by cardiac catheterization, during open heart operations for other conditions, and at autopsy. Because of the potential for comorbidities, this tumor should be removed. We present the case of an elderly man with a diagnosis of severe mitral valve regurgitation and moderate tricuspid valve regurgitation who was suspected to have a tricuspid valve vegetation. Mitral valve replacement, tricuspid valve repair, and excision of the lesion were performed successfully. A histologic examination of the vegetation confirmed it to be a papillary fibroelastoma. We present this case to emphasize the rarity of this tumor and the importance of a correct diagnosis to avoid delaying its prompt and definitive management.
    Matched MeSH terms: Mitral Valve Insufficiency/pathology; Mitral Valve Insufficiency/surgery; Mitral Valve Insufficiency/ultrasonography
  3. Doppler-echocardiographic assessment of Carbomedics prosthetic values in the mitral position
    Soo CS, Ca M, Tay M, Yeoh JK, Sim E, Choo M
    J Am Soc Echocardiogr, 1994 3 1;7(2):159-64.
    PMID: 8185960
    We prospectively studied 37 consecutive patients implanted with the Carbomedics prosthetic heart value in the mitral position (without clinical evidence of prosthetic valve dysfunction) with two-dimensional and Doppler echocardiography. The peak mitral prosthetic gradient ranged from 4.60 to 14.63 (mean 8.97 +/- 2.29) mm Hg; mean mitral prosthetic gradient ranged from 1.67 to 6.18 (mean 3.24 +/- 0.95) mm Hg; pressure half-time derived mitral valve area ranged from 1.67 to 5.30 (mean 2.70 +/- 0.80) cm2. These values compare favorably with that of another bileaflet valve (i.e., the St. Jude Medical valve). There was a wide overlap in peak and mean transmitral gradients, even with the valves of the same size, with a significant but weak inverse relationship between peak mitral gradients and valve size (p = 0.03, r = -0.36). The performance index showed a smaller range of values, again with a significant but weak inverse relationship with valve size (p = 0.001, r = -0.54). The inverse relationship between valve size and peak mitral gradient and performance index should be borne in mind when analyzing Doppler hemodynamic data.
    Matched MeSH terms: Mitral Valve
  4. Fulltext Dynamic cervical lung lobe herniation in a shih tzu dog
    Joanne, T.S.Y., Lim, M.L., Asnawi, O., Shamsul, M.A.H., Khor, K.H.
    Jurnal Veterinar Malaysia, 2019;31(1):38-42.
    MyJurnal
    An 8-year-old spayed female Shih Tzu was referred to University Veterinary Hospital (UVH) with history of chronic coughing for more than a year duration. Dry, hacking cough was heard and bilateral wheezing lung sound was noted upon physical examination. Auscultation of heart revealed left apical systolic heart murmur Grade III/VI. A soft, intermittent swelling was observed at ventral neck, cranial to thoracic inlet (protruded upon expiration and collapsed upon inspiration). Thoracic radiography taken showed presence of apical radiolucency at cervical region and bronchial pattern at caudodorsal lungs with left atrium enlargement and right-sided heart enlargement. Echocardiographic examination revealed myxomatous mitral valve disease (MMVD) with mild regurgitation. Based on diagnostic imaging, this case was diagnosed as dynamic lung lobe herniation secondary to chronic coughing concurrent with myxomatous mitral valve disease. Other differential diagnosis that may lead to chronic cough such as of tracheal collapsed and bronchiectasis was not rule out.
    Matched MeSH terms: Mitral Valve
  5. Fulltext Oesophageal perforation following transoesophageal echocardiography: A case report on successful conservative management
    Rosly NB, Loo GH, Shuhaili MAB, Rajan R, Ritza Kosai N
    Int J Surg Case Rep, 2019;61:161-164.
    PMID: 31374465 DOI: 10.1016/j.ijscr.2019.07.039
    INTRODUCTION: Transoesophageal echocardiography (TOE) is a widely used intraoperative diagnostic tool in cardiac patients, and it is considered as a safe and non-invasive procedure. However, it has its known complications, which is estimated to be 0.18% with mortality reported as 0.0098%. Complications of TOE include odynophagia, upper gastrointestinal haemorrhage, endotracheal tube malpositioning and dental injury. One of the rarer complications includes oesophageal perforation, whose incidence is reported to be 0.01%.

    CASE PRESENTATION: We present a case of a 61-year-old lady with mitral valve prolapse (MVP) who underwent TOE with subsequent presentation of odynophagia with left neck swelling. An upper endoscopy examination was inconclusive; however, a contrasted computed tomography of the neck showed evidence of cervical oesophageal perforation. She was managed conservatively and discharged well.

    DISCUSSION: The trauma caused by TOE probe insertion and manipulation accounts for most of the upper gastrointestinal complications. Mortality of patients associated with oesophageal perforation can be up to 20% and doubled if the treatment is delayed for more than 24 h. Mechanism of injury from TOE probe is likely multifactorial. Predisposing factors that increase the risk of tissue disruption include the presence of unknown structural pathology. Imaging studies and an upper endoscopy examination may aid in the diagnosis of oesophageal perforation.

    CONCLUSION: A high index of suspicion, coupled with a tailored, multidisciplinary approach, is essential to achieve the best possible outcome. Conservative management may be worthwhile in a stable patient despite delayed presentation. Although TOE is considered a safe procedure, physicians should be made aware of such a dreaded complication.

    Matched MeSH terms: Mitral Valve Prolapse
  6. Fulltext Traditional Jones criteria: limitation in the diagnosis of rheumatic fever in patients with mitral valve repair
    Putri Yubbu, Johan Aref Jamaluddin, Lydia Chang Mun Yin, Geetha Kandavello, Mazeni Alwi, Hasri Samion, et al.
    Malaysian Journal of Medicine and Health Sciences, 2020;16(2):316-319.
    MyJurnal
    The present study aims to determine the limitations of traditional Jones criteria during the first episode of acute rheu- matic fever (ARF) at the initial referral hospital, in a cohort of patients below 18 years old who had undergone mitral valve repair in National Heart Institute (IJN) from 2011 to 2016. Carditis followed by fever and joint involvement were the most frequent manifestations at first diagnosis. Of the 50 patients, only seven (14%) fulfilled the traditional Jones criteria for the diagnosis of the first episode of ARF. When compulsory evidence of a previous group A Beta he- molytic streptococcus (GABHS) was disregarded, this figure rose to 54%. Therefore, strict adherence to Jones criteria with absolute documentation of GABHS will lead to underdiagnoses of ARF. The application of echocardiographic diagnostic criteria of rheumatic heart disease (RHD) needs to be emphasized to allow early diagnosis and adminis- tration of secondary prophylaxis to prevent progression to severe valvular disease.
    Matched MeSH terms: Mitral Valve
  7. Fulltext Coughing Shih Tzu dog due to myxomatous mitral valve disease stage C2
    Khor, K.H., Jessie-Bay, J.X.
    Jurnal Veterinar Malaysia, 2018;30(1):15-19.
    MyJurnal
    Myxomatous Mitral Valve Disease is a degenerative condition of the mitral valves leaflets. A 10-year-old
    male castrated Shih Tzu was presented with primary complaint of coughing. Clinical examination revealed normal
    heart rate, respiratory rate and rectal temperature. Systolic murmur Grade IV/VI was heard at the left heart apex.
    Thoracic radiographic findings were cardiomegaly with the vertebral heart score of 11.0 and had evidence of
    cardiogenic pulmonary edema. Echocardiographic examination revealed thickening mitral valves with evidence of
    moderate regurgitation observed. Based on the findings obtained, the dog was diagnosed with Myxomatous Mitral
    Valve disease stage C2. Dog was treated with benazepril (0.5mg/kg), pimobendan (0.2mg/kg) with a combination of
    furosemide (2mg/kg). Frusemide was gradually removed from the treatment regime as coughing improved over time.
    The dog was no longer lethargy and even gained weight.
    Matched MeSH terms: Mitral Valve
  8. Fulltext Moxifloxacin-warfarin interaction
    Yew KL, Lee WC
    Med J Malaysia, 2012 Aug;67(4):420-1.
    PMID: 23082454 MyJurnal
    Matched MeSH terms: Mitral Valve*
  9. Congenital cyanotic heart disease with situs inversus totalis: an autopsy case report
    Dayapala A, Kumar V
    Am J Forensic Med Pathol, 2009 Jun;30(2):171-4.
    PMID: 19465810 DOI: 10.1097/PAF.0b013e3181875a79
    Sudden deaths because of congenital heart diseases are infrequently referred to the forensic pathologist for autopsy. Many of such deaths, if already diagnosed are released directly from the hospital without autopsy. Even forensic pathologists face a few difficulties in performing the autopsy on such infrequent cases, as they are not always updated with the anatomy of anomalies. While dealing with such cases, the concerned forensic pathologist is compelled to refer literature and textbooks again to understand the nature of developmental defects. This is especially so when dealing with cases of situs inversus accompanied by transposition of great arteries and other congenital cardiac abnormalities and variants such as single ventricle, double outlet right ventricle, Taussig-Bing variety etc. In the present case also, situs inversus with transposition of great vessels and other anomalies have been noted and studied.
    Matched MeSH terms: Mitral Valve Stenosis/pathology
  10. Fulltext Cardiac surgery in General Hospital, Kuala Lumpur: review of all open-heart operations. April 1982 to February 1987
    Awang Y, Haron A, Sallehuddin A
    Med J Malaysia, 1987 Jun;42(2):81-5.
    PMID: 3503194
    The Cardiothoracic Department, General Hospital, Kuala Lumpur which was set up in April 1982, deals with a wide range of cardiac disease, general thoracic and also vascular cases. A total of 2,450 operations were performed from April 1982 to February 1987, and 79.3% of these were for cardiac cases (open and closed heart). This paper reports a review of the 1,110 consecutive open heart operations performed by the Department during the stated period.
    Matched MeSH terms: Mitral Valve Stenosis/surgery
  11. Fulltext Symptomatic anaemia 17 years after double valve replacement
    Wong MH, Chee KH, Azman W
    Singapore Med J, 2009 Oct;50(10):e362-4.
    PMID: 19907876
    A 40-year-old Malay woman presented with increasing lethargy, palpitation and shortness of breath, 17 years after a mitral and aortic valve replacement. A Starr-Edwards prosthetic valve replaced the mitral valve, and a Bjork-Shiley prosthetic valve replaced the aortic valve. Biochemical parameters demonstrated intravascular haemolysis, as evidenced by haemoglobin 7.8 g/dL, reticulocyte count 8.4%, lactate dehydrogenase 2,057 IU/L and low haptoglobulin levels (less than 6 mg/dL). Transoesophageal echocardiography revealed a paravalvular leakage over the mitral valve. The haemoglobin levels remained persistently low despite frequent blood transfusions. She successfully underwent a second mitral valve replacement. Her anaemia resolved subsequently.
    Matched MeSH terms: Mitral Valve/surgery
  12. Is rheumatic aetiology a predictor of poor outcome in the current era of mitral valve repair? Contemporary long-term results of mitral valve repair in rheumatic heart disease
    Yakub MA, Dillon J, Krishna Moorthy PS, Pau KK, Nordin MN
    Eur J Cardiothorac Surg, 2013 Oct;44(4):673-81.
    PMID: 23447474 DOI: 10.1093/ejcts/ezt093
    Contemporary experience with mitral valve (MV) repair in the rheumatic population is limited. We aimed to examine the long-term outcomes of rheumatic MV repair, to identify the predictors of durability and to compare the repair for rheumatic and degenerative MVs.
    Matched MeSH terms: Mitral Valve/surgery*
  13. Fulltext Uncomplicated hyperemesis gravidarum does not alter the course of cardiovascular changes during pregnancy
    Sheila Rani Kovil George, Sivalingam Nalliah
    International e-Journal of Science, Medicine & Education, 2014;8(1):34-43.
    MyJurnal
    The purpose of this prospective longitudinal study was to investigate the maternal cardiac haemodynamic and structural changes that occur
    in pregnancies with uncomplicated hyperemesis gravidarum in a selected Malaysian population. Nine women underwent serial echocardiography beginning at 12 weeks of gestation and throughout pregnancy at monthly intervals. Their echocardiograms were repeated at 6 and 12 weeks following delivery to reflect the pre-pregnancy haemodynamic state. Cardiac output was measured by continuous wave Doppler at the aortic valve. Interventricular septum thickness was determined by M- mode echocardiography and ventricular diastolic function by assessing flow at the mitral valve with Doppler recording. Cardiac output showed an increase of 32.9% at 36 weeks and maintained till 40 weeks of gestation. Heart rate increased from 79 ± 6 to 96 ± 8 beats/min at 36 weeks. Stroke volume increased by 16.4 % at 40 weeks of gestation when compared to the baseline
    value. Systolic and diastolic blood pressure did not appreciably change but showed a lower reading during the mid-trimester period. Early inflow velocity of left ventricle did not show a rise while peak atrial velocity showed an increasing trend; thus the ratio of early inflow to peak atrial transport showed a declining trend from early pregnancy to term. End diastolic dimension of left ventricle and interventricular septum thickness showed an increased value at term. Uncomplicated hyperemesis gravidarum did not alter the haemodynamic changes throughout pregnancy and concur with established data for normal pregnancy.
    Matched MeSH terms: Mitral Valve
  14. Fulltext Myxomatous mitral valve disease in a Shih Tzu dog
    Teoh, Y.B., Khor, K.H.
    Jurnal Veterinar Malaysia, 2017;29(1):18-22.
    MyJurnal
    An 11-year-old intact male Shih Tzu dog was referred to the University Veterinary Hospital (UVH) with history of coughing and laboured breathing. Auscultation revealed that the dog had a left systolic heart murmur grade V/VI at the base of the heart. Radiography showed findings of cardiomegaly and pulmonary oedema. Echocardiography findings revealed that dog has a myxomatous mitral valve disease. The mitral valve was severely thickened and prolapsed into the left atrium. Congestive heart failure (CHF) was treated with an angiotensin converting enzyme (ACE) inhibitor and diuretic. An anti-mucolytic agent was prescribed as a symptomatic treatmentfor the coughing that could be due to mild bronchitis. Dog did not response well with treatment as the frequency of cough was not reduced and the duration was longer each time. Pimobendan was then added on to the initial treatment and there was a tremendous improvement seen from the patient after that. Episodes of productive cough were noticed greatly reduced and dog was much more active at home post two weeks of ACE inhibitor, diuretic and dual-acting inodilator. We successfully maintained the dog with minimal coughing episodes. However, the prognosis is moderate to poor in this case due to possibilities of refraction towards medications.
    Matched MeSH terms: Mitral Valve
  15. Complete heart block in young adult with acute rheumatic fever
    Nor Hidayah ZA, Azerin O, Mohd Nazri A
    Med J Malaysia, 2018 10;73(5):323-325.
    PMID: 30350813 MyJurnal
    Acute Rheumatic fever (ARF) is commonly associated with ECG abnormalities particularly atrioventricular block. However, third degree atrioventricular block or complete heart block is a rare manifestation. Most cases occurred in children. We reported a 25 year old man who developed complete heart block during an acute episode of ARF. He presented to hospital with five days history of fever, malaise and migrating arthralgia, followed by pleuritic chest pain. One day after admission his electrocardiogram (ECG) revealed complete heart block. Transthoracic echocardiography showed good left ventricular function with thickened, mild mitral regurgitation with minimal pericardial effusion. ASOT titer was positive with elevated white blood count and acute phase reactant. A temporary pacemaker was inserted in view of symptomatic bradycardia. The complete heart block resolved after medical therapy. He was successfully treated with penicillin, steroid and aspirin. He was discharged well with oral penicillin. The rarity of this presentation is highlighted.
    Matched MeSH terms: Mitral Valve Insufficiency
  16. Immigrant Health Study. 2. Clinical findings in migrant workers - a pilot study. [Abstract]
    Chia YC, McCarthy S
    JUMMEC, 1998;3:60-61.
    This section only examines the clinical findings and some blood chemistly in these workers. A total of 222 men and 28 women were studied. Their ages ranged from 12 to 57 years, the mean being 30.1 (±7.4). Generally most of the physical examination was normal and no external features of infectious diseases were seen. The mean systolic and diastolic blood pressure was 120 (±13) and 76(±8.7) nun Hg respectively. About 8.4% of the population had elevated blood pressure of 140/90 mmHg or greater. About 12.4% of these man and women were underweight (Body mass index (EMI) less than 19 kg/m2) while 11.2% were either overweight or obese (BMI>25) with the mean being 21.8 (±2.7). Only 3 had BMI greater than 30. Three subjects had a lnitral regurgitation murmur thought to be due to mitral valve prolapse. Four others had tinea cruris, six had insignificant axillary lymph-nodes, five had cervical lymph-nodes of which one was due to carcinoma of the tonsil 30 with shotty inguinal lymph-nodes which was thought to of no pathological significance. Four subjects had crepitations and five had rhonchi in their lungs. A full blood count revealed that 16.65% of the man and 32.1°/o of the women had haemoglobin levels of less than 14gm/dl and 12gm/dl respectively. The most striking abnormality was the high prevalence of eosinophilia. 37% of the subjects had eosinophilia counts of greater than 450/dl. About 19.4% of this study population had fasting blood glucose of greater than 6mmol/l but only 1.3% with fasting blood glucose of greater than 7.8 mmo/l. About 22% of the urine examined revealed pro- teinuria but were otherwise unremarkable for the other parameters. This group of foreign workers was made up of a presumably fairly healthy young population. Attempts to look for infectious disease on physical examination, not surprisingly did not reveal any remarkable findings. It could be that the majority of these subjects already had a examination prior to coming into the country and another one soon after arrival. However an indirect measurement of infectious diseases via the eosinophilic count revealed a high prevalence of parasitic infestations. Attempts to examine the end results of social hardship, be it intrinsic before or appearing after arrival indirectly shoved some degree of suffering. There was a fairly high prevalence of anaemia, especially amongst the women. The body mass index also revealed this population to be generally less obese than other populations. The value of medical check-ups has been debated, especially if it were done as a pre-employment procedure. This pilot study has shown that it is not cost-effective to do physical examination or blood chem- istry and urine analysis in hying to identify infectious diseases in the migrant workers. In the light of the paucity of clinical findings in this pilot study, it would be prudent to review the strategy for examining the health status of migrant workers. Perhaps the physical examination can be dispensed with, and blood andurine analysis beveryfocused and directedin order to maximise the cost- effectiveness of this programme. Certainly the high prevalence of eosinophilia needs further evalua- tion.
    Matched MeSH terms: Mitral Valve
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