Effect of main pancreatic duct suture ligation on the prevention of clinically relevant pancreatic fistula after distal pancreatectomy: analysis of 82 consecutive patients.

OBJECTIVE: This study aimed to examine the factors linked to the development of clinically significant pancreatic fistulas following distal pancreatectomy (DP) and to assess the efficacy of suture ligation of the main pancreatic duct. PATIENTS AND METHODS: A single-center retrospective study was performed on the medical records of 82 patients who underwent DP in our institution between January 2011 and December 2019. RESULTS: There were 28 males (34.1%) and 54 females (65.9%). The patients' age ranged from 18 to 86 years (median: 55.5 years). Indications for DP included primary pancreatic disease (n=63, 76.8%) and non-pancreatic disease (n=19, 23.2%). Postoperative mortality and morbidity rates were 3.7% and 48%, respectively. Pancreatic parenchymal closure was accomplished by a hand-sewn technique or mechanical stapling in 89 and 13 patients, respectively. Identification of the pancreatic duct and suture ligation was performed in 46 patients (56.1%). Pancreatic fistula was developed in 20 patients (24.4%); 12 fistulas were classified as Grade B, and 8 as Grade C. Biochemical leaks (Grade A) were identified in 8 patients (9.8%). Multivariate analysis indicated that failure to ligate the main pancreatic duct was the only variable associated with an increased risk for pancreatic leak (p=0.031; odds ratio=0.233; 95% confidence interval, 0.062-0.879). CONCLUSIONS: Pancreatic leak remains a common complication after DP. The incidence of leaks is reduced significantly when the main pancreatic duct is identified and directly ligated during DP.

Multimodal Treatment of Chylous Fistula: A Retrospective Case-Control Study.

Chylous fistulas (CF) are rare surgical complications and there is no standard treatment. This study presents the treatment modalities performed on patients who developed CF over a 10-year period. During the observation period, CF developed in 29 patients, 16 of whom were women. The mean age was 55.76± 13.48. Lymphatic duct injury was mostly seen in the abdomen (58.6%) and the most common reason was nephrectomy (20.7%). Extended lymphatic dissection due to malignancy was performed in 82.7% of all cases. Chylous leakage started postoperatively on 3.78±3.94 days (range: 1-19 days). Fasting, total parenteral nutrition (TPN), and somatostatin treatment were applied to all patients, and 75.8% of the fistulas were resolved completely with medical treatment. Surgical ligation of the lymphatic canal was performed in 7 patients. One was not successful and underwent percutaneous embolization of the thoracic lymphatic leakage cavity. All fistulas were resolved in 18.18±10.4 days. The resolution time and hospital stay were significantly higher in thoracic fistulas (p=0.017; p=0.003, respectively). In addition, malignant cases had longer resolution time (32.40±28.72 vs 16.27±11.25, p=0.036) and hospital stay (35.0±29.74 vs 16.25±14.05p= 0.002 respectively) than non-malignant. There was no chylothorax, chylous ascites, or recurrence at 20.55±22.88 months follow-up. Treatment of CF with fasting, TPN, and somatostatin analogs are effective. Other interventions such as surgical ligation with or without fibrin glue and interventional radiology treatments may be considered when conservative treatments fail.

First Harvest of Pediatric and Congenital Heart Surgery Multicenter Database in Turkey: Novel Application of Real-Time Online Reporting.

OBJECTIVES: A new congenital heart surgery database (CKCV) with real-time online reporting function was recently developed in Turkey. All standard international parameters were used, but Aristotle Comprehensive Complexity score was modified. In this study, the first analysis of the CKCV Database is reported. METHODS: The CKCV Database included 2307 procedures from 12 centers between January 2018 and March 2020. All parameters, including 10 real-time online reports, which represent the number of centers, number and mortality rates of all procedures, number of extracorporeal membrane oxygenation (ECMO) and results, details of postoperative complications, age-group statistics, analysis for priority status, mean intensive care and hospital stay durations of the procedures, results of Aristotle Basic, Modified Aristotle Comprehensive (MACC) and Society of Thoracic Surgeons-European Association (STAT) Score Categories, comparison of centers were analyzed. RESULTS: Most common 10 procedures were ventricular septal defect (VSD) repair (n = 273), tetralogy of Fallot (TOF) repair (n = 243), atrial septal defect (ASD) repair (n = 181), complete AVSD repair (n = 95), cavopulmonary anastomosis (n = 81), systemic to pulmonary shunt (n = 79), modified Fontan (n = 71), subaortic resection, (n = 66) PA banding (n = 66), and arterial switch operation (n = 66). Cardiopulmonary bypass was used in 84.6% of the procedures. Overall mortality rate was 6.0%. A total of 618 major and 570 minor complications were observed in 333 and 412 patients, respectively. According to six MACC categories, number of the patients and mortality rates were I (293; 0.3%); II (713; 1.4%); III (601; 3.3%); IV (607; 12%); V (84; 35.7%); and VI (9; 55.6%), respectively. Analysis of five STAT Categories showed 0.7, 3.8, 5.4, 14.9, and 54.7% mortality rates. CONCLUSIONS: CKCV Database has a great potential for nationwide quality improvement studies. Users could instantly analyze and compare their results to national and international aggregate data using a real-time online reporting function. This is the first multicenter congenital database study in Turkey.

Oncological Outcomes of Hepatic Resection vs Transplantation for Localized Hepatocellular Carcinoma.

BACKGROUND: Scarce data are available comparing outcomes of hepatic resection vs orthotopic liver transplantation (OLT) for localized hepatocellular carcinoma (HCC) patients both meeting and exceeding the Milan criteria. This study compared the clinical and oncological outcomes of patients undergoing hepatic resection vs transplantation localized HCC. METHOD: Between January 2005 and February 2017, clinical and oncological outcomes of patients who underwent liver resection (n = 38) vs OLT (n = 28) for localized HCC were compared using a prospectively maintained database. RESULTS: A total of 66 patients (with a median age of 62) who met the study criteria were analyzed. Comparable postoperative complications (13.2% vs 28.6%, P = .45) and perioperative mortality rates (7.9% vs 10.7%, P = .2) were noted for the resection vs OLT groups. While Child-Pugh Class A patients were more prevalent in the resection group (78.9% vs 7.1%, P = .0001), the rate of patients who met the Milan criteria was higher in the OLT group (89.3% vs 34.25, P = .0001). Recurrence rates were 36.8% in the resection group and 3.6% in the OLT group at the end of the median follow-up period (32 vs 39 months, respectively). The HCC-related mortality rate was significantly higher in the resection group (39.5% vs 10.7%, P = .034). However, a subgroup analysis of patients who met the Milan criteria revealed similar rates of recurrence and HCC-related mortality (15.4% vs 8%, P = .63). Based on logistic regression analysis, number of tumors (P = .034, odds ratio: 2.1) and "resection"-type surgery (P = .008, odds ratio: 20.2) were independently associated with recurrence. CONCLUSION: Compared to liver transplantation, hepatic resection for localized hepatocellular carcinoma is associated with a higher rate of recurrence and disease-related mortality.

Are there any effects of chronic carbon monoxide exposure on argyrophilic nucleolar-organizing region-associated protein synthesis in rat myocardium?

The aims of the study are to detect whether there are any possible effects of chronic carbon monoxide (CO) exposure on the argyrophilic nucleolar-organizing region (AgNOR)-associated protein synthesis and evaluate any possible relationship between the amount of AgNOR protein and the level of myocardial injury also and between AgNOR and histopathological evaluation methods. Adult male albino Wistar rats (n = 18) were randomly divided into three groups (groups A, B, and C). Group A served as control, while groups B and C were rats exposed to CO gas chronically (1000 and 3000 ppm CO concentration with a flow rate of 4 L/min for 30 min/day for 7 days, respectively). Total AgNOR area/nuclear area (TAA/NA) and the mean AgNOR numbers for each myocyte nucleus were determined. There were significant differences among all groups for TAA/NA ratio. These differences were not significant for mean AgNOR numbers. According to the histopathological evaluation scores, there were significant differences between the groups. The differences were significant among the groups for loss of sarcomere pattern. A strong positive correlation between histopathological injury scores and TAA/NA ratio was found (Rsq = 0.48; p = 0.002), however, the correlation was not significant for mean AgNOR numbers (Rsq = 0.08; p = 0.25). In conclusion, TAA/NA ratio can be used as an indicator for obtaining information about the level of myocardial damage instead of histopathological evaluation scores.

Can argyrophilic nucleolar organizing region-associated protein amount be used for the detection of cardiac damage?

INTRODUCTION: Carbon monoxide (CO) is a colorless, tasteless, odorless, nonirritant gas and CO poisoning affects all organ systems. AIM: We aimed to detect any possible effects of CO exposure on the argyrophilic nucleolar organizing region (AgNOR)-associated protein synthesis of heart cells and whether there is any relationship between AgNOR protein amount and both carboxyhemoglobin (COHb) level and histopathological evaluation methods used for the detection of damage in heart tissue after CO exposure. MATERIALS AND METHODS: The rats were divided into four groups (control, 1000, 3000, and 5000 ppm), each containing six rats. After CO intoxication, COHb levels were measured and the animals were killed on the 7th day. AgNOR staining was performed in the heart tissue. One hundred nuclei per rat were evaluated, and total AgNOR area/nuclear area and mean AgNOR number were analyzed for each nucleus. The CO exposure groups had significantly higher AgNOR values than the control group (p < 0.0001). According to cardiomyopathy (CMY) scoring methods, the differences between groups 3 and 4 and groups 1 and 2 were significant (p < 0.05). A significant positive correlation between AgNOR values and both CMY and COHb levels were detected. CONCLUSION: The detection of AgNOR protein amount may give information about the CMY levels and be used to detect the CO intoxication levels instead of COHb in later periods.

Characteristic imaging findings of duodenal perforation.

Two patients were admitted to emergency room with complaint of abdominal pain with abrupt onset and retroperitoneal free air was detected in pararenal area on CT. In this paper, characteristic CT findings of patients diagnosed with duodenal perforation are presented under the light of literature data.

The role of neutrophil to lymphocyte ratio as a predictor of diastolic dysfunction in hypertensive patients.

OBJECTIVE: Neutrophil to lymphocyte ratio (NLR) is a novel parameter for cardiovascular research area. The higher values of NLR have been found to be associated with worse clinical outcomes in atherosclerotic heart disease, heart failure, heart valve disease and other various cardiovascular disorders. Although the relationship between NLR and almost all cardiovascular disorders have been investigated, the association between NLR and diastolic dysfunction remains unclear. We herein evaluated the association between NLR and diastolic dysfunction. PATIENTS AND METHODS: The study population consisted of 41 hypertensive patients with any grade of diastolic dysfunction and 41 hypertensive patients without diastolic dysfunction determined by echocardiographic evaluation constituted the control group. RESULTS: Mean NLR value was found to be 2.07 ± 0.82 in the diastolic dysfunction group while the control group had a mean value of 1.69 ± 0.60 (p = 0.020). The patients with diastolic dysfunction had significantly higher values of NLR. When grades of diastolic dysfunction were evaluated, NLR was 1.80 ± 0.82, 2.32 ± 0.73 and 2.75 ± 0.45 in patients with grade 1, grade 2 and grade 3 diastolic dysfunction, respectively. The patients with higher grade of diastolic dysfunction had higher values of NLR (p = 0.001). None of the other hematologic parameters differed significantly in patients with diastolic dysfunction when compared to controls. CONCLUSIONS: Patients with diastolic dysfunction had higher values of NLR compared to subjects without diastolic dysfunction. Furthermore higher grades of diastolic dysfunction were associated with higher levels of NLR. Further studies are needed to search the possible use of NLR as a marker for prognostic stratification in diastolic dysfunction which is associated with worse cardiovascular outcomes.

Assessment of patients who presented to the emergency department with mushroom poisoning.

OBJECTIVE: This study aimed to assess the demographic characteristics, emergency department (ED) complaints, laboratory findings, and latent phase periods of patients who presented to the ED due to mushroom poisoning (MP) as well as the efficacy of conventional and hemofiltration therapies. METHOD: The study was conducted on patients who presented to the ED with MP between 2010 and 2012. The patient's demographic characteristics, complaints at the ED, latent phases, laboratory findings, and treatments of MP cases were evaluated. RESULTS: The mean age of patients was 38.03 ± 15.96, where 63.8% of them were female and 36.2% were male. Visits occurred most frequently in the autumn (32.6%). When presenting to the ED, the most frequent complaint was nausea-vomiting. The aspartate aminotransferase (AST), alanine aminotransferase (ALT), international normalised ratio (INR), and blood urea nitrogen values of patients with a latent phase between 0 h and 5 h were significantly lower than the values of patients with a latent phase between 6 h and 24 h. In this study, 62% of the patients (n = 36) had stomach lavage and received activated charcoal. Altogether, 55.2% of the patients had received conventional therapy, 37.9% of them received hemofiltration, and all of them received supportive treatment. The AST, ALT, and INR values of those who had received hemofiltration and conventional therapies were significantly higher than of those who received only supportive treatment (p < 0.01). CONCLUSION: Hemofiltration, in combination with conventional therapy, seems to be an effective treatment for reducing mortality in suspected MP cases involving late acting toxins.

Is one-time carbon monoxide intoxication harmless? Evaluation by argyrophilic nucleolar-organizing regions staining method.

In carbon monoxide (CO) poisoning, CO affects the oxygen-carrying capacity of the hemoglobin molecule. Nucleolar-organizing regions (NORs) are genetic loci on chromosomes that are composed of ribosomal DNA and proteins. NORs can be stained with silver. A total of 18 rats were exposed to CO in three different concentrations (1000, 3000, and 5000 ppm) with 6 rats as controls. The animals were euthanized 7 days after CO intoxication. Lung tissues were taken, embedded in paraffin blocks, and sectioned at 5 µm thickness. Argyrophilic nucleolar-organizing region (AgNOR) staining was carried out. One hundred nuclei per individual were evaluated, and total AgNOR number per total nuclear number and total AgNOR area per nuclear area (TAA/NA) for each nucleus were analyzed. The CO exposure groups had significantly higher TAA/NA values and AgNOR numbers than the control group (p < 0.05). Although the differences between 1000 ppm and the other two CO-exposed groups were meaningful (p < 0.05) in the TAA/NA values, there were no differences among the CO exposure groups for the AgNOR number (p > 0.05). The increase in TAA/NA value depends on the increase in the CO exposure. Significant correlations between both the AgNOR values and histopathological scoring methods were found. Therefore, AgNOR staining method may be used as an indirect indicator for evaluating the degree of cell damage rate.

Predictors of missed injuries in hospitalized trauma patients in the emergency department.

AIM: To determine the extent of missed injuries in patients hospitalized with major trauma in a Turkish Level 1 emergency department. We also tried to identify the primary factors contributing to each missed injury and to determine their subsequent adverse short-term clinical outcomes. METHODS: This is a retrospective analysis of prospectively collected data on a cohort of trauma patients. Trauma patients were divided into two groups: patients with missed injury and others. Logistic regression was used to define factors affecting "missed injury". RESULTS: A total of 670 hospitalized trauma patients were included. The incidence of missed injuries in the patients and the rate of missed injury per patient were 13.3% (95% CI 6-20) and 1.64, respectively. The most frequently missed diagnosis was injuries of the musculoskeletal system (38%; 95% CI 30-46). It was "clavicle fracture and/or dislocation" (35%; 95% CI 16-53) when the rate of missed diagnosis according to the frequency of the specific injury was calculated. A multiple logistic regression analysis showed that the predictors of missed injuries were patient's age (OR 0.74, 95% CI 0.63-0.87), total number of injuries (OR 1.74, 95% CI 1.38-2.20), and ISS (OR 1.10, 95% CI 1.03-1.18). Radiological errors were prominent in almost 90% (95% CI 85-95). Missed injury caused additional hospital stay (30%; 95% CI 21-40) and additional surgery was required (15%; 95% CI 8-23). CONCLUSION: The study highlights the need for a trauma team approach and the need for support of radiological report in the ED.

Left cervical aortic arch in conjunction with a complex arch aneurysm and subaortic left innominate vein.

We present a patient with left cervical aortic arch who had a complex aortic arch aneurysm consisting of multiple saccular aneurysmatic excavations, proximal aortic arch narrowing, a right subclavian artery aneurysm and subaortic left innominate vein diagnosed by computed tomographic angiography.

Mutations in APC, CTNNB1 and K-ras genes and expression of hMLH1 in sporadic colorectal carcinomas from the Netherlands Cohort Study.

BACKGROUND: The early to intermediate stages of the majority of colorectal tumours are thought to be driven by aberrations in the Wnt (APC, CTNNB1) and Ras (K-ras) pathways. A smaller proportion of cancers shows mismatch repair deficiency. The aim of this study was to analyse the co-occurrence of these genetic alterations in relation to tumour and patient characteristics. METHODS: In a group of 656 unselected sporadic colorectal cancer patients, aberrations in the APC, K-ras, CTNNB1 genes, and expression of hMLH1 were investigated. Additionally, tumours were divided in groups based on molecular features and compared with respect to patient's age at diagnosis, sex, family history of colorectal cancer, tumour sub-localisation, Dukes' stage and differentiation. RESULTS: Mutations at the phosphorylation sites (codons 31, 33, 37, and 45) in the CTNNB1 gene were observed in tumours from only 5/464 patients. Tumours with truncating APC mutations and activating K-ras mutations in codons 12 and 13 occurred at similar frequencies (37% (245/656) and 36% (235/656), respectively). Seventeen percent of tumours harboured both an APC and a K-ras mutation (109/656). Nine percent of all tumours (58/656) lacked hMLH1 expression. Patients harbouring a tumour with absent hMLH1 expression were older, more often women, more often had proximal colon tumours that showed poorer differentiation when compared to patients harbouring tumours with an APC and/or K-ras mutation. CONCLUSION: CTNNB1 mutations seem to be of minor importance in sporadic colorectal cancer. The main differences in tumour and patient characteristics are found between groups of patients based on mismatch repair deficiency.

Coronary reoperations without the use of cardiopulmonary bypass.

BACKGROUND: Reoperations of coronary artery surgery still carry a higher mortality and morbidity rate, compared to primary revascularization procedures. Coronary artery bypass reoperations without the use of cardiopulmonary bypass (CPB) is a potential strategy that has been developed to decrease mortality and morbidity. MATERIALS AND METHODS: Between 1978 and 2000, 113 patients were reoperated for coronary artery revascularization, 32 (28.3%) cases on beating heart without the use of CPB (Group II) and 81 (71.7%) cases under CPB and cardioplegic arrest (Group I). Mean age of Groups I and II were 61.3+/-5 and 57.4+/-7.3 years, respectively. RESULTS: Statistically significant difference was found between the two groups, favoring off pump surgery in the early postoperative findings with respect to low cardiac output, postoperative myocardial infarction and postoperative hospitalization duration until discharge. Operative mortality was not statistically different between groups and these figures for cardiopulmonary and off pump groups were 11/81 (13.5%), 1/32 (3.1%), respectively. CONCLUSION: Reoperations of coronary artery revascularization surgery without the use of CPB is more economic, necessitating less manipulations, free of side effects of CPB, less time consuming surgical procedure compared to reoperations performed under standard techniques. When performed with a refined technique and true indications, off pump coronary reoperations have mortality and morbidity advantages over the surgery performed under CPB, improvements in techniques and instruments off pump strategy must be in the surgeons armamentarium in coronary reoperations.

Mg++SO4 treatment improves the hemodynamics following the acute myocardial ischemia and reperfusion.

BACKGROUND: The effect of Mg++SO4 on myocardial hemodynamics was investigated in this study. METHODS: Twelve dogs were entered in this research. Six dogs received Mg++SO4 and the remaining dogs were considered as controls. The amount of Mg++SO4 that was administered to the animals was 0.15 mmol/kg/hr each. The left anterior descending artery was occluded for a period of 1 hour and the drug was administered during reperfusion. RESULTS: Two hours after reperfusion, cardiac output was 1275+/-50 ml/min in the control group and 1475+/-25 ml/min in the Mg++SO4 group (p<0.05), pulmonary capillary wedge pressure was 18+/-3 mmHg in the control group and 12+/-2 mmHg in the Mg++SO4 group. CONCLUSIONS: In this study it was shown that Mg++SO4 usage after 1 hour arterial occlusion and 2 hours reperfusion protects the heart from the adverse effects of ischemia/reperfusion and had a better central hemodynamics.

Spontaneous false aneurysm of left internal mammary artery.

A 15-year-old female patient presented with a history of a mass just medial to the left breast and fever. Her physical examination revealed upper extremity hypertension, delayed and diminished pulsations in the femoral arteries and a midsystolic murmur over the back. On catheterization of the aorta a 45 mmHg systolic pressure gradient was obtained across the coarctation segment. The selective left internal mammary artery angiography showed the relationship of distal portion with false aneurysm. A magnetic resonance scan showed a left parasternal mass extending anteriorly.

Is left main coronary artery stenosis a risk factor for early mortality in coronary artery surgery?

It is accepted universally that the treatment of critical left main coronary artery (LMCA) stenosis is surgical revascularization. This study was designed to evaluate critical LMCA stenosis as a risk factor in coronary artery bypass surgery. We compared the surgical results of 760 patients with critical LMCA disease, including 58 cases who were operated under emergency conditions (LMCA-em) and 702 patients who were operated electively (LMCA-el), with randomly chosen 707 coronary bypass patients (CONT-el) without LMCA disease, but who had double- or triple-vessel disease. Another group of patients (n = 99) who were operated on under emergency conditions (CONT-em) but without LMCA disease were also compared with the corresponding groups. The mortality of LMCA-em group and CONT-em group was markedly higher from the other two groups. Univariate analysis revealed that female gender, older age, presence of diabetes mellitus, poor left ventricular function, and the presence of unstable angina were major risk factors for fatal outcome in LMCA-el and CONT-el groups. Age was also a risk factor in LMCA-em group, as well as unstable angina pectoris. The coexistence of critical right coronary artery disease did not affect the early outcome in both groups with LMCA lesions. In the multivariate analysis, critical LMCA disease was not a risk factor for mortality. Logistic regression analysis revealed diabetes [odds ratio (OR): 3.66], poor left ventricular function (higher left ventricle end-diastolic pressure, OR: 1.08), and emergent operations (OR: 5.09) were risk factors for early mortality. Patients with LMCA disease should have surgery promptly for favorable results, because emergency conditions have higher mortality rates.

ATP-MgCl2 utilization for spinal cord protection during experimental thoracic aortic occlusion.

BACKGROUND: In this experimental study we investigate the effect of intravenous ATP-MgCl**2 administration for prevention of spinal cord injury occurring due to ischemia induced by aortic cross clamping. METHODS: Ten rabbits were studied. The abdominal aorta is ligated below the left renal artery. Five rabbits served as a control group and received no medication during 30 minutes of ischemic period. The other 5 rabbits received during 30 minutes of aortic occlusion ATP-MgCl2 solution (100 micromol/ml for each). Distal and proximal aortic pressures are measured during the procedure and incisions are closed. Rabbits are observed for 24 hours for their neurological status and scored accordingly. Specimens from the spinal cord are taken for electron microscopic investigations. RESULTS: All of the control group rabbits were paraplegic. One of the ATP-MgCl2 group rabbits was paraparesic and the others were normal Distal aortic pressure was 9+/-3 mmHg for the control group and was 17+/-4 mmHg for the ATP-MgCl2 group (p<0.05). Electron microscopic studies showed the preserved ultrastructure for ATP-MgCl2 group. CONCLUSIONS: ATP-MgCl2 administration during spinal cord ischemia reduces spinal cord injury. This may be an alternative modality for the protection of the spinal cord during aortic surgery.

Long term results of mitral valve replacement with preservation of the posterior leaflet.

BACKGROUND AND AIMS OF THE STUDY: It is commonly held that preservation of the annulo-ventricular continuity during mitral valve replacement has a beneficial effect on postoperative ventricular function. This paper presents our eight-year experience with this technique. MATERIALS AND METHODS: From 1986 to December 1992, 120 patients with rheumatic valve disease underwent mitral valve replacement (MVR) combined with preservation of the posterior leaflet of the mitral valve. The mean age was 33.87 years (range 16 to 63). The preoperative New York Heart Association (NYHA) class was III in 64% of the patients and IV in 3%. The early (30 day) mortality rate was 2.5% (3/120). Follow up was 100% complete. The total cumulative follow up was 477 patient-years (pty) with a mean 3.94 years (range: 2-8 years). RESULTS: The actuarial survival rate (including hospital mortality) was 87.6% at eight years. Advanced age (p = 0.0457), increased preoperative functional capacity (p = 0.0251), increased preoperative end-systolic diameter (p = 0.0352) and combined tricuspid reconstruction (p = 0.0001) were found to be independent parameters for a lower actuarial survival rate. Six patients (1.25%/pty) developed thromboembolic complications. Two of these were cerebrovascular accidents (0.41%/pty) and four were caused by mechanical valve thrombosis (1.83%/pty). Freedom from thromboembolic complications (including mechanical valve thrombosis) was 89.8% +/- 7.9%. Fifteen patients (3.14%/pty) developed valve failure, four (0.83%/pty) mechanical valve thrombosis and nine (1.88%/pty) bioprosthetic valve failure. Freedom from reoperation was 60.7% +/- 16.1%. One patient with a St. Jude Medical valve (0.2%/pty) suffered from prosthetic valve endocarditis. Three patients (0.62%/pty) died during the follow up period, and, freedom from all valve related complications was 51.4% +/- 16.1% at eight years. CONCLUSION: Preservation of the posterior leaflet during mitral valve replacement reduces the risk of early mortality and did not cause additional complications to the patients. Despite the beneficial effects of this technique in the long term this technique did not increase the long term survival in patients with associated impaired valvular and/or ventricular function.

Pseudoaneurysm of the tibioperoneal trunk.

A young woman with an iatrogenic coagulation defect related to a mechanical mitral valve prosthesis developed a pseudoaneurysm of the tibioperoneal trunk after a minor blunt injury. The importance of minor blunt trauma in such cases and the surgical approach are reviewed.