Management of Isolated, Congenital Anterior Mitral Valve Cleft

Background: Isolated anterior mitral valve clefts (MVC) are rare congenital heart defects, and data are limited regarding the natural history and surgical outcomes for such isolated MVCs. Methods: We conducted a retrospective review of patients with congenital MVC who were evaluated at Mayo Clinic in Rochester, Minnesota between 1993 and 2020. Patients were separated into two cohorts: those who underwent surgical repair of the MVC and those who had not yet undergone repair. Baseline and postoperative clinical and echocardiographic data were analyzed. Results: Fourteen patients were included in the nonsurgical cohort and eight patients in the surgical cohort. Surgical repair was via primary median sternotomy (n = 6) or robot-assisted, minimally invasive (n = 2). All cleft repairs were performed by simple suture closure. Intraoperative evaluation of the clefts did not reveal additional structural factors that could account for the mitral regurgitation (MR). At latest follow-up of the surgical cohort, the median grade of MR was 1 (range 0-1), and median left ventricular ejection fraction was 65% (IQR 59%-67%), both similar to the immediate postoperative result. At latest follow-up, all patients in the nonsurgical cohort were NYHA Class 1, and median MR grade was 1. All patients were asymptomatic (NYHA Class 1). Conclusions: Our findings corroborate prior reports that MVC repair is safe and successful and is followed by a low rate of recurrent mitral valve dysfunction. Durable surgical repair of isolated, congenital MVC can be performed safely in select patients. The decision to intervene should be based on the severity of mitral regurgitation and patient symptoms rather than the presence of the MVC alone.

Midterm outcome and strength assessment after proximal rectus femoris refixation in athletes

Purpose Proximal rectus femoris avulsions (PRFA) are relatively rare injuries that occur predominantly among young soccer players. The aim of this study was to evaluate midterm postoperative results including strength potential via standardized strength measurements after proximal rectus femoris tendon refixation. It was hypothesized that the majority of competitive athletes return to competition (RTC) after refixation of the rectus femoris tendon without significant strength or functional deficits compared to the contralateral side. Methods Patients with an acute (< 6 weeks) PRFA who underwent surgical refixation between 2012 and 2019 with a minimum follow-up of 12 months were evaluated. The outcome measures compiled were the median Tegner Activity Scale (TAS) and mean RTC time frames, Harris Hip Score (HHS), Hip and Groin Outcome Score (HAGOS) subscales, International Hip Outcome Tool-33 (iHOT-33), and Visual Analog Scale (VAS) for pain. In addition, a standardized isometric strength assessment of knee flexion, knee extension, and hip flexion was performed to evaluate the functional result of the injured limb in comparison to the uninjured side. Results Out of 20 patients, 16 (80%) patients were available for final assessment at a mean follow-up of 44.8 ± SD 28.9 months. All patients were male with 87.5% sustaining injuries while playing soccer. The average time interval between trauma and surgery was 18.4 ± 8.5 days. RTC was possible for 14 out of 15 previously competitive athletes (93.3%) at a mean 10.5 ± 3.4 months after trauma. Patients achieved a high level of activity postoperatively with a median (interquartile range) TAS of 9 (7–9) and reported good to excellent outcome scores (HHS: 100 (96–100); HAGOS: symptoms 94.6 (89.3–100), pain 97.5 (92.5–100), function in daily living 100 (95–100), function in sport and recreation 98.4 (87.5–100), participation in physical activities 100 (87.5–100), quality of life 83.1 ± 15.6; iHot-33: 95.1 (81.6–99.8)). No postoperative complications were reported. Range of motion, isometric knee flexion and extension, as well as hip flexion strength levels were not statistically different between the affected and contralateral legs. The majority of patients were “very satisfied” (56.3%) or “satisfied” (37.5%) with the postoperative result and reported little pain (VAS 0 (0–0.5)). Conclusion Surgical treatment of acute PRFA yields excellent postoperative results in a young and highly active cohort. Hip flexion and knee extension strength was restored fully without major surgical complications. Level of evidence Retrospective cohort study; III.

Basal cell carcinoma of the antihelix- reconstruction using a pre-auricular flap

We present the case of an 80-year-old female patient with a lesion on the right antihelix of the pinna that examined in the outpatient ENT Department of our hospital. A surgical excision of the lesion was performed, under local anesthesia. We used a superficial based pre- auricular flap to reconstruct the defect. The final postoperative result was satisfactory. The histological examination revealed a basal cell carcinoma.

Sternal reconstruction and omentoplasty after mediastinitis

Deep sternal infections are serious complications after open heart surgery. We present a case of a 59-year-old female with uncontrolled diabetes who underwent aortocoronary bypass surgery in another cardiac surgery department. After the surgical intervention sternal dehiscence and wound infection occurred, which was followed by two unsuccessful attempts for sternal refixation.&nbsp;Two months after the initial procedure the patient was admitted to our institution with severe dyspnea and paradoxical movement of the thorax. Computed tomography revealed a huge defect of the sternum and metal osteosynthesis with a titanium plate and omentoplasty was performed.&nbsp;The patient was followed-up for one year with excellent postoperative result.

A Case Series : Hymenoplasty Based on The Type of The Tear or Cleft Preoperation Finding For Good Satisfaction Postoperative Result

Purpose: To describe our surgical hymenoplasty technique based on the type of the tear or cleft finding preoperative for satisfaction postoperative. Patient and methods: Hymenoplasty was performed on 4 patient on January 2017 until March 2017, we found three patients with U-type, 1 patient with V-type. And we performed hymenoplasty which is to create a new surface raw, on the right and left cleft to be stiched, we use a rapid absorbable suture material, with horizontal mattress technique. Results: No complications developed in the patients who had undergone hymenoplasty and all patients stated that the sexual intercourse they experienced was similar to the night of the initial experience. Discussion : Our new apporach for hymenoplasty is a technique that has good results, and this is a good approach in doing hymenoplasty.

Fulminant Infective Endocarditis Due to Kingella Kingae and Several Complications in a 6-Year-Old Girl: A Case Report

Kingella kingae is a gram-negative coccobacillus belonging to the HACEK group (Haemophilus species, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) and is a common oropharyngeal colonizer of healthy young children. Osteoarticular infection is the most commonly reported invasive Kingella kingae infection in children, usually presenting a mild clinical picture. However, it can also cause severe invasive infections, especially infective endocarditis, with a high complication rate. We report the case of a 6-year-old girl, with no past medical history, who presented with fulminant infective endocarditis due to Kingella kingae. She received emergency venoarterial extracorporeal membrane oxygenation support, rapidly underwent cardiac surgery, and was then treated using ceftriaxone for 4 weeks as recommended by the American Heart Association. The patient's postoperative course was marked by a cerebral ischemic stroke consistent with septic embolism. She also presented with a para-aortic pseudoaneurysm that required a secondary surgical procedure, with a good postoperative result. This report illustrates a case of fulminant infective endocarditis due to Kingella kingae and responsible for two major complications. We also describe the preventive valve surgery performed to ensure the preservation of valve function and its capacity for growth.

The experience of using negative power IOLs for a cataract complicated by extremely high myopia

Purpose. To analyze the postoperative result of visual and refractive functions in patients with extremely high myopia, taking into account the initial changes in the macular zone and rather complex calculations of the optical power of negative aphakic IOLs. Materials and methods. On the basis of S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, 57 negative aphakic IOLs were implanted over the past 3 years, which amounted to an average of 0.14% of the total number of implanted IOLs. All patients who were supposed to have a negative IOL implanted in the list of preoperative diagnostics included OCT of the posterior segment of the eye and ultrasound scanning to assess the existing degenerative changes in the posterior segment of the eye. Results. The average visual acuity before surgery in the group of emmetropes was ±0.32, and in patients with extremely high myopia, visual acuity did not exceed 0.1 in 2018, 0.23 in 2019, and 0.22 in 2020. In the operated extreme myopes, the mean BCVA increased to ±0.43, which is slightly lower than the average BCVA of the operated emmetropes during the same period (±0.58). None of the patients had intraoperative complications. Posterior capsule opacification was noted in 20 cases (35%) within 12-14 months after cataract surgery, which is several times higher in comparison with emmetropes, where posterior capsule opacification is observed in 8-15%, depending on the IOL model. Conclusion. This group of patients requires a particularly careful preoperative diagnosis, as well as surgery with increased caution due to the presence of concomitant pathology of the posterior segment of the eye. The experience of using negative IOLs for cataract in patients with extremely high myopia has shown good results in relation to postoperative visual and refractive functions, despite the fact that BCVA in extreme myopes after surgery is limited by the initial changes in the macular zone. Key words: negative aphakic IOLs, extremely high myopia, complicated cataract.

COMPARISON BETWEEN RADIOGRAPHIC METHODS OF MEASURING FLEXIBILITY IN SCOLIOSIS

ABSTRACT Objective: To determine the preoperative radiographic method for measuring the Cobb angle that is closest to the postoperative result in patients with scoliotic deformity. Methods: Retrospective cohort study of radiographic spinal evaluation (preoperative posteroanterior (PA), bending, traction, traction under anesthesia and immediate postoperative posteroanterior (PO)) of 26 patients treated surgically for scoliotic deformities during the period from January 2017 to September 2019. The final mean Cobb angle and its decrease in relation to the PA value were evaluated in the three curves in patients with idiopathic (IS) and non-idiopathic scoliosis. Results: All the mean curve values were statistically significant, except for bending in non-idiopathic scoliosis (non-IS). The mean traction under anesthesia values were closer to the PO values. Regarding the delta (decrease) of the maneuvers in relation to the PA, no statistical significance was observed in the non-IS group. The traction under anesthesia maneuver had a greater delta in all curves. Conclusions: The traction under anesthesia maneuver in patients with idiopathic scoliosis is the method with the greatest flexibility and which best predicts the postoperative result. Level of evidence III; Diagnostic study.

Photographic Misrepresentation on Instagram After Facial Cosmetic Surgery: Is Increased Photography Bias Associated With Greater User Engagement?

Background Before and after images are commonly used on Instagram to advertise aesthetic surgical treatments and are a powerful means of prospective patient engagement. Consistency between before and after images accurately demonstrating the postoperative result on Instagram, however, has not been systematically assessed. Objectives Our aim was to systematically assess facial cosmetic surgery before and after photography bias on Instagram. Methods The authors queried 19 Instagram facial aesthetic surgery-related hashtags on 3 dates in May 2020. The “top” 9 posts associated with each hashtag (291 posts) were analyzed by 3 plastic surgeons using 5-item rubric quantifying photographic discrepancies between preoperative and postoperative images. Duplicate posts and those that did not include before and after images after facial aesthetic surgery procedures were excluded. Results A total of 3,477,178 posts were queried. Photography conditions were observed to favor visual enhancement of the post-operative result in 282/291 analyzed top posts, with an average bias score of 1.71/5 (± 1.01). Plastic surgeons accounted for only 27.5% of top posts. Physicians practicing outside their scope of practice accounted for 2.8% of top posts including a general surgeon, dermatologist, dentist, ophthalmologist, and maxillofacial surgeon. Accounts with a greater number of followers (p = 0.017) and posts originating from Asia (p = 0.013) were significantly associated with a higher post-operative photography bias score. Conclusions Photographic misrepresentation, with photography conditions biased towards enhancing the appearance of the postoperative result, is pervasive on Instagram. This pattern was observed across all physician specialties and raises significant concerns. Accounts with a greater number of followers demonstrated significantly greater postoperative photography bias, suggesting photographic misrepresentation is awarded by greater user engagement.

Clinical and Radiological Outcomes of Operative Therapy in Insertional Achilles Tendinopathy With Debridement and Double-Row Refixation

Background: Insertional Achilles tendinopathy (IAT) is a painful pathology in which the strongest and thickest tendon of the human body is affected. Different conservative and operative treatments have been described to address this pathology. This study aimed to evaluate the medium-term clinical and radiological outcomes of patients who underwent a surgical therapy via a longitudinal tendon-splitting approach with debridement and double-row refixation. Methods: All patients were assessed pre- and postoperatively using a visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score, the Foot and Ankle Outcome Score (FAOS), and the Foot Function Index (FFI). Additionally, a lateral radiograph of the foot was performed to assess the postoperative result. Forty-two patients with confirmed IAT who underwent surgery between 2013 and 2017 with a longitudinal tendon-splitting approach and tendon refixation using a double-row refixation system were evaluated. The average follow-up was 32.8 (range, 18-52) months. We included 26 female and 16 male patients with an average age of 56.8 (range, 27-73) years. Results: The mean VAS improved from 8.91 ± 1.0 preoperatively to 1.47 ± 2.5 postoperatively ( P < .01). AOFAS scores improved significantly from 51.0 ± 12.5 preoperatively to 91.3 ± 14.3 postoperatively ( P < .01). All total and subscores of the FFI and FAOS saw a significant improvement at follow-up ( P < .01). Lateral radiographs showed recurrent calcification in 30 patients (71.4%). Conclusion: We found that, at an average of 33 months posttreatment, insertional Achilles tendinopathy via a longitudinal tendon-splitting approach resulted in good outcomes for patients after failure of initial conservative therapy. Recurrent calcification seems to be very common but shows no association with inferior outcomes or the return of symptoms. Level of Clinical Evidence: Level IV, retrospective case series.