Entrenamiento de sprint mediante el uso de trineo y paracaídas

El entrenamiento individualizado de carreras específicas con medios resistidos es una importante herramienta para la mejora de la velocidad. En virtud a la demanda de esta capacidad para el buen desempeño de los jugadores de béisbol, se reconoce como objetivo del presente estudio diseñar un entrenamiento de sprint mediante el uso de trineo y paracaídas. Se planifica un cuasiexperimento, con dos grupos: control y experimental y en dos momentos: pre y postest. La etapa experimental se desarrolla durante la pretemporada, conformada por una muestra de diez sujetos con 20.84 años de edad y 79.82 kg. de peso promedio. Se emplearon como métodos teóricos el analítico-sintético, inductivo-deductivo, histórico-lógico, sistémico-estructural-funcional y como empíricos el análisis de contenido, la observación, la medición. Para la medición de la velocidad lineal, las variables analizadas son el test de 60 yardas y los test de fuerza máxima del trineo y de squat. Los resultados alcanzados indicaron mejoras significativas en el grupo experimental en los tres test realizados, con % de incrementos iguales a 3.48, 7.25 y 7.46 % respectivamente. Además, se obtiene que existe una elevada correlación entre la fuerza máxima del trineo y la de squat con respecto al peso de rendimiento al esfuerzo de los atletas, con coeficientes de Pearson iguales a 63.6 % y 62.9 % respectivamente y para un 95 % de confianza. Se demuestra que el entrenamiento resistido nos proporciona información clave en la fase de velocidad máxima para la mejora del rendimiento de sprint en el béisbol.

O treinamento individualizado de corridas específicas com mídia resistida é uma ferramenta importante para melhorar a velocidade. Em virtude da demanda desta capacidade para o bom desempenho dos jogadores de beisebol, é reconhecido como um objetivo do presente estudo projetar um treinamento de sprint usando trenó e pára-quedas. Está prevista uma quase-experimentação, com dois grupos: controle e experimental e em dois momentos: pré-teste e pós-teste. A fase experimental ocorreu durante a pré-época, com uma amostra de dez sujeitos de 20,84 anos de idade e pesando uma média de 79,82 kg. Os métodos teóricos utilizados foram analítico-sintético, indutivo-dedutivo, histórico-lógico, sistêmico-estrutural-funcional, e os métodos empíricos foram análise de conteúdo, observação e medição. Para a medição da velocidade linear, as variáveis analisadas foram o teste das 60 jardas e os testes de resistência máxima do trenó e do agachamento. Os resultados alcançados indicaram melhorias significativas no grupo experimental nos três testes realizados, com aumentos de % iguais a 3,48, 7,25 e 7,46 %, respectivamente. Além disso, obtém-se que existe uma alta correlação entre a força máxima do trenó e o agachamento com relação ao peso do desempenho de esforço dos atletas, com coeficientes de Pearson iguais a 63,6 % e 62,9 % respectivamente e para um 95 % de confiança. Demonstra-se que o treinamento resistido nos fornece informações chave na fase de velocidade máxima para a melhoria do desempenho do sprint no beisebol.

The individualized training of specific races with resisted means is an important tool for the improvement of speed. Due to the demand of this capacity for the good performance of baseball players, the objective of this study is to design a sprint training using sled and parachute. A quasi-experiment is planned, with two groups: control and experimental and in two moments: pre-test and post-test. The experimental stage is developed during the pre-season, conformed by a sample of ten subjects with 20.84 years of age and 79 82kg. of average weight. Theoretical methods used were analytical synthetic, inductive-deductive, historical-logical and systemic-structural-functional. The empirical methods were content analysis, observation and measurement. For the measurement of linear speed, the variables analyzed are the 60-yard test and the maximum strength tests of the sled and squat. The results achieved indicated significant improvements in the experimental group in the three tests performed, with % increases equal to 3.48, 7.25 and 7.46 respectively. In addition, it is obtained that there is a high correlation between the maximum strength of the sled and the squat with respect to the weight of the athletes' effort performance, with Pearson coefficients equal to 63.6 % and 62.9 % respectively and for a 95 % of confidence. It is demonstrated that resisted training provides key information in the maximum velocity phase for the improvement of sprint performance in baseball.

The use of the single purse-string parachute suturing technique for pancreaticojejunostomy in laparscopic pancreaticoduodenectomy / 中华肝胆外科杂志

Objective:To study the single purse-string parachute suturing technique for pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy, and to determine its feasibility and safety.Methods:The clinical data of 71 patients who underwent laparoscopic pancreaticoduodenectomy using the single purse-string parachute suturing technique for pancreaticojejunostomy from October 2018 to October 2021 at the Second Hospital of Hebei Medical University were retrospectively analyzed. There were 41 males and 30 females, with age (59.1±9.7) years old. The operative time, intraoperative blood loss, complication rate and other data were analyzed.Results:All 71 patients successfully underwent total laparoscopic pancreaticoduodenectomy, with 5 patients who underwent 2D laparoscopic surgery and 66 patients 3D laparoscopic surgery. There were additional vascular resection and reconstruction in 2 patients. The operative time was (388.9±92.9) min, the intraoperative blood loss was (411.3±176.9) ml, and the postoperative hospital stay was (14.1±5.8) d. The operation time of 71 patients who underwent the single purse-string parachute technique of pancreaticojejunostomy was (26.9±6.8) min. Postoperative complications occurred in 18 patients (25.4%). Grade B pancreatic fistula occurred in 2 patients (2.8%), and the longest time for removal of abdominal drain was 17 days after operation. Among the 71 patients, complications including biliary fistula occurred in 6 patients (8.5%), delayed gastric emptying in 5 patients (7.0%), pulmonary infection in 4 patients (5.6%), non-pancreatic fistula-related abdominal infection in 4 patients (5.6%), non-pancreatic fistula-related abdominal bleeding in 1 patient (1.4%), biliary tract bleeding in 1 patient (1.4%), and chylous leakage in 2 patients (2.8%).Conclusion:The single purse-string parachute technique of pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy had the advantages of being safe and reliable. The procedure is worthy of furthers promotion.

Disease characteristics and surgical effect of 22 children with Shone′s syndrome / 中华实用儿科临床杂志

Objective:To analyze the characteristics and surgical outcomes of Shone′s syndrome in children, and to explore the surgical treatment strategy and technical key.Methods:Retrospective study.Children with Shone′s syndrome treated in the Pediatric Heart Center, Beijing Anzhen Hospital, Capital Medical University from May 2013 to June 2019 were retrospectively analyzed for their baseline characteristics and surgical data.The data were compared by Student t-test. Results:A total of 22 children with Shone′s syndrome were recruited, involving 15 males (68.2%) and 7 females (31.8%). There were 6 cases (27.3%) of complete form of Shone′s syndrome and 16 cases (72.7%) of incomplete form.No deaths were reported.The postoperative mitral valve velocity [(149.7±38.2) cm/s vs.(234.9±34.0) cm/s, t=7.341, P<0.05], left ventricular outflow tract velocity [(202.0±105.0) cm/s vs.(328.6±120.3) cm/s, t=6.575, P<0.05] and aortic arch coarctation velocity [(186.1±60.9) cm/s vs.(347.9±100.8) cm/s, t=7.630, P<0.05]were significantly lower than those of preoperative levels.There were no complications occurred at 1-year follow-up, and 91.7% of the patients were followed up for 3 years, and 80.2% were followed up for 5 years without complications, 2 cases needed reoperation. Conclusions:Surgical treatment of Shone′s syndrome achieved satisfactory outcomes.Early diagnosis and early intervention are beneficial to children with Shone′s syndrome, although they need to be followed up and have the risk of reoperation in the long term.

Effect Of Dynamic Neuromuscular Stabilization Therapy Vs Parachute Resistance Training On Performance Level In Race Walkers: Comparative Study

Background: Race walking significantly places stress on the lower extremity joints affecting ADLs. The gait pattern of race walking is different than normal walking that causes biomechanical alterations leading to musculoskeletal disabilities. DNS (Dynamic Neuromuscular Stabilization) therapy is based on developmental kinesiology and the integration of neurophysiology and biomechanical principles in which each purposeful movement pattern is reinforced by the coordination between every segmented required for postural stability. Parachute Resistance training works on the principle of air resistance and terminal velocity, which helps in improving lower extremity muscle strength and power, decreasing the stress put on joints during physical activity. Methods: The study was completed by using a stratified sampling technique among the race walkers between the age group of 18-29 years, a total of 40 race walkers (20 males and 20 females) were selected based on the inclusion and exclusion criteria by approaching various sports academies. Participants were divided into two groups, Group A and Group B. The groups consisted of 20 participants each. They were verbally interviewed regarding their demographics. Pre-treatment assessment of vo2max and speed was done using the Cooper test and sprint test, respectively. Participants in group A underwent Dynamic Neuromuscular Stabilization Technique, and group B underwent a Parachute resistance training program, and post-treatment assessment of all the parameters was done. Results: DNS Therapy shows significant improvement in the performance level of race walkers in group A as compared to Group B with p-value 0.003 and 0.001. Conclusion: The study concluded that DNS therapy and Parachute resistance training exercises are equally effective in improving the performance level in race walkers.

Incomplete Form of Shone Complex in an Adult Congenital Heart Disease Patient / 대한흉부외과학회지

Shone complex is a rare congenital disorder that involves 4 obstructive lesions of the left heart, as follows: parachute mitral valve, supravalvular mitral ring, subaortic stenosis, and coarctation of the aorta. Incomplete forms with 2 or 3 of these lesions in adult patients have been rarely reported in the literature, meaning that insufficient general data exist concerning the surgical strategy and clinical follow-up. Herein, we report the case of a 31-year-old woman with a diagnosis of incomplete form of Shone complex with parachute mitral valve and coarctation of the aorta who underwent successful single-stage surgical repair.

Clinical application of parachute-like-suture double-pouch pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy / 中华肝胆外科杂志

Objective To introduce the detailed surgical procedure of parachute-like-suture double-pouch pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy (LPD),and to study its clinical results.Methods A retrospective study was conducted on 31 patients who underwent parachute-like-suture double-pouch pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy between January 2016 and June 2018 in our department.Results Of 31 patients who underwent total laparoscopic pancreaticoduodenectomy,5 patients underwent two-dimensional (2D) LPD and 26 underwent three-dimensional (3D) LPD.Total mesopancreas excision (TMpE) was performed in 12 patients,including 2 patients combined with PV-SMV segmental resection and reconstruction.The mean operative duration,and mean estimated blood loss,post-operative hospital stay were 412.8 ± 102.4 min,462.8 ± 396.7 ml,14.7 ± 8.9 d,respectively.The operating time of parachute-like-suture double-pouch pancreaticojejunostomy was 29.7 ± 6.8 min (20 ～45 min).Post-operative complications occurred in 8 patients (25.8％),3 of whom suffered from more than two types of complications.There were 2 patients (6.5％) with postoperative B/C grade pancreatic fistula,4 patients with postoperative biliary leakage (12.9％),3 patients with delayed gastric emptying (9.7％),1 patient with portal vein thrombosis (3.2％) and 1 patient with peritoneal effusion (3.2％).One patient died during perioperative period due to gastrointestinal hemorrhage.Conclusions Parachute-like-suture double-pouch pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy was a simple,convenient,reliable method.It is worthy of clinical promotion and further studied.

Effects of Different Landing Postures on Bone Mineral Density and Content During High-Impact Exercises / 医用生物力学

Objective To study effects of different types of high-impact exercises on the increment of bone mineral density (BMD) and bone mineral content (BMC) . Methods Thirty-nine male volunteers, including 13 hoopsters, 13 paratroopers, and 13 common college students as the control, were recruited and divided into two subgroups (subgroup 1:20-22 years old; subgroup 2:23-25 years old). Their BMDs and BMCs on calcaneus, first through fifth metatarsus, hip, and lumbar spine (L1-4) were evaluated. Results The BMC of calcaneus, the first and second metatarsals, total lumbar spine, and total hip in the hoopster group was significantly higher than that in the control group and paratrooper group. The hoopster group obtained statistically higher BMD at the lumbar spine, hip, and femoral neck than the other two groups. However, the BMCs and BMDs of the paratrooper group and control group had no significant differences at almost all measured anatomical locations. Conclusions BMC and BMD are not always in positive correlation with vertical ground reaction forces during normal exercises. Compared with parachuting training, playing basketball as a kind of variable load exercise can effectively increase BMC and BMD, and is more beneficial for reducing the risk of osteoporotic fracture.

Progress in surgical treatment of parachute mitral valve / 中华实用儿科临床杂志

The parachute mitral valve is a rare group of heart valve diseases that are typically characterized by only one papillary muscle.All the chordae tendineaes are connected to the papillary muscle and shaped like a para-chute.It mainly causes mitral stenosis and occasionally leads to mitral regurgitation. Due to the early appearance of clinical symptoms and rapid development of the disease,early accurate diagnosis and surgical treatment are needed. Common surgical treatments are mitral valve repair and mitral valve replacement.Now,the progress of surgical treatment of ＂parachute－like＂ mitral valve malformation was reviewed in order to provide a meaningful reference for its surgical treatment.

Safety and Efficacy of Percutaneous Ventricular Partitioning in Ischemic Heart Failure Patients With Apical Aneurysm / 中国循环杂志

Objective: To evaluate the safety and efifcacy of percutaneous ventricular partitioning (PVP) in ischemic heart failure (IHF) patients with apical aneurysm. Methods: A total of 19 IHF patients with apical aneurysm at the age of (68.1 ± 8.2) years were enrolled. The patients received PVP operation with adequate clinical and medical imaging examinations; the safety of operation was evaluated and post-operative clinical events with cardiac function were followed-up. Results: There were 18/19 (95%) patients with successful PVP and 1 had to stop the operation due to unsatisfactory landing of ventricular partitioning device. 2 patients suffered from vessel access related complication and received femoral artery stent implantation. With (252 ± 170) days follow-up study, no post-operative device failure, cardiac death, thromboembolism and HF re-hospitalization occurred. At 3 months after operation, the patients had improved NYHA classiifcation (2.72 ± 0.67) vs (1.67 ± 0.59) and 6 min walk test (462 ± 96) m vs (484 ± 87) m, bothP<0.01. Echocardiography indicated that post-operative left ventricle end-diastolic volume index (LVEDVI) decreased form (137.4 ± 19.1) ml/m2 to (125.6 ± 18.5) ml/m2,P=0.0056 and LVESVI decreased from (89.7 ± 22.3) ml/m2 to (78.8 ± 20.7) ml/m2,P=0.0019; while LVEF increased from (34.8 ± 8.13) % to (41.3 ± 6.2) %, P=0.031. Conclusion: Our preliminary experience showed that with adequate evaluation, PVP was safe and effective in IHF patients with apical aneurysm; short-term follow-up study implied the improved hemodynamic and cardiac function.

Echocardiographic diagnosis of parachute mitral valve / 中华超声影像学杂志

Objective To explore the value of echocardiography in the diagnosis of the parachute mitral valve(PMV).Methods The echocardiographic characteristics of 12 patients with PMV between 2005 and 2012 were reviewed retrospectively,including the morphology,movement and blood flow of mitral valve apparatus,and other associated cardiac abnormalities.Results Of the mitral valve leaflets in these 12 cases,all were thickened and opened restricted in diastole.Axial view showed that in all cases mitral valves opened eccentrically and in 2 cases they didn't close tightly.Each patient only had single papillary muscle in left ventricle,which received all chords of mitral valves.Of papillary muscles in these patients,4 were located at posteromedial wall,3 at anterolateral wall,2 at middle posterior wall,2 at apical wall,and 1 at posterolateral wall.Of the 12 patients,only one were simple PMV,11 had associated cardiovascular anomalies,2 had mild regurgitation in systolic period and 11 had increased trans-valve peak flow velocity.Conclusions Echocardiography is reliable in the diagnosis of PMV,which could provide a comprehensive evaluation of valvular lesions and other associated cardiovascular anomalies.

Síndrome de Shone incompleto: a propósito de un caso diagnosticado en la adultez / Incomplete Shone's syndrome. Apropos of a case diagnosed in adulthood

El síndrome de Shone constituye una rara entidad cardíaca congénita que consiste en la presencia de lesiones estructurales obliterantes de hemicardio izquierdo que incluyen: anillo supravalvular, válvula mitral en paracaídas, estenosis sub-aórtica y coartación aórtica. Es poco frecuente que curse en su forma incompleta. El caso que a continuación se presenta, describe el síndrome de Shone incompleto detectado en un adulto

Shone's syndrome is a rare congenital heart disease consisting in the presence of obliterating structural lesions on the left side of the heart, including supravalvular ring, parachute mitral valve, subaortic stenosis and aortic coarctation. The incomplete form of the disease is not common. The presentation describes a case of incomplete Shone's syndrome diagnosed in adulthood

Efeitos do treinamento de força específico no desempenho de nadadores velocistas treinados com parachute / Specific muscular strength performance at swimmers sprinters trained with parachute / Especificaciones de rendimiento fuerza muscular en nadadores velocistas con paracaídas

OBJETIVO: verificar os efeitos do treinamento de força específico no desempenho de nadadores velocistas. METODOLOGIA: dois grupos de nadadores randomizados em treinados sem (TSP, n: 8) e com parachute (TCP, n: 12) foram submetidos a treinamento de 12 semanas (6 x semana; 1 sessão de 2 h/dia), sendo avaliados a força muscular (FMMI); a força específica (FE) e o tempo de sustentação de força (TSF); o número de braçadas em 50m (NB 50m); o tempo e a velocidade de nado em 15 (V 15m) e 50m (V 50m), antes e após o protocolo. RESULTADOS: após o programa de treinamento, não ocorreram modificações na FMMI e V 15m para ambos os grupos. Nas demais variáveis houve melhora significante (p < 0,05) no grupo TCP: FMMS (> 18 por cento); FE (> 30 por cento); TSF (> 35 por cento); NB 50m (< 23 por cento); V50 m (> 16 por cento). O grupo TSP apresentou melhora no TSF (> 9 por cento). CONCLUSÃO: o emprego do parachute foi eficiente em melhorar os parâmetros de força e no desempenho no teste de 50m.

AIM: this study was undertaken to evaluate the role of parachute on specific muscular strength performance at sprinters swimmers. METHODS: twenty sprinter swimmers were randomized in two groups: without (WP, n: 8) and MP: with (MP, n: 12) parachute. The swimmers trained 6 days per week for 12 weeks (1 x day; 2 h). The following performance tests were carried: specific strength (SS) and maintenance time of strength (MSS); swimming velocity in 15m (SV 15) as well as in 50m (SV 50) and stroke number at 50m (SN 50). RESULTS: after training program, there were not changes on SL and SV 15 for both groups. For all the other variables, were showed significant (p < 0,05) improvement to MP group: SS (> 30 percent); MSS (> 35 percent); SV 50 (> 16 percent); SN 50 (< 23 percent). The WP group only showed a significant improvement on MSS (> 9 percent). CONCLUSION: the parachute was efficient to improve specific muscular strength parameters as well as performance at 50m test at swimmers sprinters performance.

OBJETIVO: evaluar el papel de Paracaídas en el desempeño de los nadadores velocistas. METODOLOGÍA: nadadores velocista fueron aleatorizados en dos grupos (no parachute entrenado (TSP, n: 8) y entrenó con paracaídas (TCP, n: 12). El treinamiento fue equivalente para ambos grupos, formados por 12 semanas (6 x semana 1; 2 h/dia período de sesiones). Fueron avaliaciadas: la fuerza muscular (FMMI); en los estados desarrollados (FS) y la fuerza de mantenimiento específica máximo (TSF) durante la natación, el número de trazos en 50m (NB 50m), el tiempo y la velocidad de natación desarrollado en 15 (V 15m) y 50m (V 50m), respectivamente. RESULTADOS: después de que el programa de capacitación, no hubo cambios en FMMI y V 15m los grupos. En todas las demás variables en el ANOVA fue la mejoría significativa (p < 0,05) en TCP: FMMS (> 18 por ciento), Fe (> 30 por ciento), TSF (> 35 por ciento); NB 50m (< 23 por ciento); V 50m (> 16 por ciento). TSP mostró una mejoría en TSF (> 9 por ciento). CONCLUSIÓN: el uso de paracaídas fue eficaz en la mejora de los parámetros de fuerza específica el rendimiento en los 50m de los nadadores velocistas.

Application of emulational trunk dummy in evaluating the opening shock of life saving parachute / 医用生物力学

Objective To carry out quantitative investigation on application of emulational trunk dummy (ETD) in evaluating the opening shock of life saving parachute and provide a more reliable test method for further development. Method ETD equipped with parachute was tested in the impact experiment, where a 63.4 kg impact block was dropped from the height of 0.20 m，0.40 m，0.60 m，0.80 m respectively to simulate different opening shocks. The opening shocks were deducted by measured forces on harness and acceleration loads at the center of dummy's thorax. For comparison, 5 rigid trunk dummies (RTD) were tested under the equivalent impacts. As the contrast test, 24 male healthy subjects were also exposed under such impacts with standing and sitting posture respectively. Results Under the same impact, the peak impact value on harness exhibited maximum on RTD, minimum on subjects with sitting posture, and medium on ETD. There were significant differences between each experimental group (P<0.01). With different impact loads, the peak impact value on ETD was 2 795，3 873，4 816 and 5 736 N respectively, which was correspondingly close to that of subjects with standing posture(2 541，3 042，3 720 and 4250 N). Conclusions The result of opening shock gathered from ETD is closer to that from RTD due to ETD’s viscoelasticity, which shall certainly influence the measured opening shock. Therefore, ETD is suggested to be used in the development of live saving parachute.

Alterações fisiológicas do salto de paraquedas, uma revisão / Physiological alterations associated with parachute jumping, a review

Os esportes radicais são caracterizados por um forte componente de risco e aventura, sendo responsáveis por desencadear elevados níveis de estresse psicológico e fisiológico. O estresse é uma reação do organismo que ocorre em função de alterações psicológicas e fisiológicas desencadeadas no indivíduo, quando esse se depara com situações que o amedrontam, excitam, confundem ou até mesmo promovem sensações de prazer. Assim, este artigo visa contribuir com a compreensão das alterações fisiológicas, ocorridas no organismo de praticantes de pára-quedismo, em decorrência do salto. Para elaboração do manuscrito foram consultadas as bases de dados Web of Science, Medline e Scielo com as palavras-chaves: parachute jumping, skydiving, psychological stress, epinefrine, norepinephrine and lactate. Com base nos estudos investigados, foi constatado que devido ao estresse psicológico ocasionado pelo salto de pára-quedas, há um aumento nos níveis plasmáticos de adrenalina, noradrenalina, lactato, cortisol, sódio e potássio, que a longo prazo podem trazer conseqüências a saúde.

Radical sports are characterized by a strong component of risk and adventure, promoving high levels of psychological and physiologic stress. Stress is a reaction of the organism that it happens due to the psychological and physiologic alterations, when the individual faces situations of fear, excitement, confuses, or even situations that promote pleasure sensations. Thus, the purpose of this article is contribute with the understanding of the physiologic alterations, that it happen in the organism of parachutists praticing, due to the jump. Databases Web of Science, Medline and Scielo were consulted for elaboration of this review, by search with the keywords parachute jumping, skydiving, psychological stress, epinephrine, norepinephrine and lactate. Based on the investigated studies, was evidenced that psychological stress caused by parachute jumping there is a increase in the plasmatic levels of the epinephrine, norepinephrine, lactate, cortisol, sodium and potassium that the long-time can have consequences for the health.

Two Cases of Double-Orifice Mitral Valve Detected by Echocardiography

Double-orifice mitral valve is a rare congenital anomaly. Most cases of double-orifice mitral valve are hemodynamically normal and remain symptomless, so that it is usually discovered incidentally in autopsy or during surgical correction of a cardiovascular abnormality. Recently, however, it is increasingly recognized as such, since the echocardiography has gained wide acceptance as a non-invasive diagnostic tool by the M-mode, two-dimensional and color Doppler echocardiogram. Two separate mitral valve apparatuses can be used on the M-mode echocardiogram. In the two-dimensional echocardiography, the parasternal and subcostal short-axis views can show two separate glass-like orifices in the left ventricle, and the parasternal long-axis view as well as the apical four-chamber view can show the anomaly. And the color Doppler echocardiogram can visualize two mosaic-pattern flows between the left atrium and ventricle. We present herewith two cases of double-orifice mitral valve, as diagnosed by means of echocardiography. The first case was an isolated one with mitral stenosis, showing two parachute mitral valves. The second was associated with perimembranous ventricular septal defect, and showed the accessory mitral valve directly attached to the ventricular septum, with the chordae crossing the ventricular outflow tract.