ABSTRACT
A successful surgical correction of an incomplete endocardial cushion defect (ECD) with an ostium primum defect in a 63-year-old man is reported. Incomplete ECD with ostium primum defect often causes severe heart failure in infancy. Reports of its surgical correction in elderly patients are few. The patient had upper abdominal discomfort and grade 1 mitral valve regurgitation. The preoperative diagnosis was complete ECD (Rastelli type A) because we misdiagnosed a leakage from a cleft between the left superior leaflet and the left inferior leaflet for a flow through a ventricular septal defect when we analyzed a preoperative left ventriculography. The importance of not misdiagnosing the leakage and echocardiography in preoperative diagnosis of ECD was therefore realized. The operative procedure involved patch closure of the ostium primum defect and mitral valve annuloplasty by Kay's procedure and the mitral valve regurgitation completely disappeared. The postoperative course was uneventful. The upper abdominal discomfort and cardiomegaly improved. If there is no severe dysfunction of other organs, surgical correction of incomplete ECD should be recommended even for elderly patients.
ABSTRACT
A study was conducted to investigate the influence on the shoulder joint of throwing during water polo. One hundred sixty-seven water polo players were interviewed about injuries caused by water polo, and 70 players claimed to have had shoulder pain.<BR>In 21 players, clinical examinations were performed, and in 31 players, assessment of external rotation stability was made. Then three-dimensional analysis of hand-to-hand shoot motion was performed in 7 players.<BR>The results were as follows;<BR>1. The painful phases of the throwing motion were the take-back phase and the acceleration phase, the pain being present at the anterior and lateral portions of the shoulder joint, <BR>2. Assessment of stability revealed that the external rotation displacement on the affected side was significantly larger than that on the control side in the injured players.<BR>3. Analysis of hand-to-hand shoot motion revealed that the external rotation angle in the acceleration phase was significantly larger in non-injured subjects than in the injured.<BR>4. The external rotation angle after ball contact was increased in the injured, but decreased in the non-injured.<BR>5. To prevent injury, it appears important to catch and throw the ball using the upper extremity and rotation of the trunk in a high body position in the water, and to strengthen the muscles of the shoulder.