Mitral valve repair with GORE-TEX artificial chordae is effective, safe, and associated with low operative mortality and low rates of valve-related complications at long-term follow-up. Artificial chordae showed excellent biologic adaptation, retaining flexibility and tension with time.

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The major finding of our study is that patient-prosthesis mismatch does not affect left ventricular mass regression in patients older than 65 with pure aortic stenosis who underwent mechanical aortic valve replacement. In older patients with low cardiac output requirements, even a small change in the valve effective orifice area after aortic valve replacement with modern efficient mechanical prosthesis, will result in a marked reduction of pressure gradient and this will be associated with a significant regression of left ventricular mass.

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ACE inhibitors prior to surgery confer added myocardial protection during surgical revascularization. Prospective, randomized clinical trials will be necessary to better define the role of ACE inhibitors in improving outcomes when they are prescribed prior to coronary artery bypass graft surgery.

It is reported that the mortality rate for combined coronary bypass grafting and mitral valve replacement is greater than for either isolated operation. To evaluate the effects of various predicting factors we analyzed the results of 67 consecutive patients undergoing combined mvr and CABG. The mean age was 61.3 +/- 7 years. There were 55 males and 12 females and the mean follow-up was 59.4 +/- 7 months. The hospital mortality rate was 13.4% (9/67). Preoperative NYHA functional class (p<0.05), left-ventricular motion score (increased scores indicating impaired function, (p<0.05), and aortic cross-clamp time (p<0.05) were associated with hospital mortality. There was no significant relationship of age (>60), cause of mitral valve disease, severity of mitral regurgitation, number of grafts, or previous myocardial infarction with hospital mortality. There were 7 late deaths, and survival at five years was 76.1%. Although there was a trend for preoperative NYHA class and aortic cross-clamp time to be associated with late survival, the only factor significantly related to late survival was global wall-motion score (p<0.05). Severity of mitral regurgitation and cause of mitral valve disease have been reported as being related to late survival, but we have found no such relationship. Our results indicate that both hospital and late mortality are strongly correlated with preoperative left ventricular function.

Mutilating, horrifying, aggressive basal cell carcinoma (BCC) is a rare cutaneous neoplasm. We report a case of mutilating BCC of the face and its peculiar histologic features. The primary lesion, before therapy, demonstrated typical BCC in association with lobules of metatypical cells. The recurrent BCC, after radiation therapy, had a metatypical pattern. We believe that the metatypical BCC is a potentially aggressive lesion. It is essential for this tumor to be recognized early and treated surgically.

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