Background: Aortic Valve Replacement (AVR) is usually done through median sternotomy. The present study aimed to compare the right ANTEROLATERAL thoracotomy and median sternotomy approaches for AVR.Methods: The present prospective study was conducted on 60 patients who had aortic valve disease and were subjected to AVR. Thirty patients underwent aortic valve replacement via right ANTEROLATERAL thoracotomy (study group) and thirty patients via median sternotomy (control group). Statistical analysis was done using Mann Whitney U test and Fischer’s Exact test. Statistical Package SPSS 17 was used for data analysis.Results: The mean length of the incision was 18.7±1.8 cm in the patients who had undergone AVR through median sternotomy, while 7.8±0.9 cm in the study group patients. Besides, the mean bypass time was 121.8±18.6 minutes for the patients who had undergone AVR through median sternotomy, while 122.1±20.8 minutes for the study group. In addition, the mean aortic cross clamp time was 67.7±13.4 minutes for the patients who had undergone AVR through median sternotomy, while 68.0±8.9 minutes for the study group. The mean operating time was 181.6±31.5 minutes for the patients who had undergone AVR through median sternotomy, while 190.8±29.8 minutes for the study group. Patient satisfaction with respect to cosmesis was higher in the study group. Only 50% of the patients who had undergone AVR through median sternotomy in comparison to 73.3% of those in the study group were satisfied with the cosmesis.Conclusions: The right ANTEROLATERAL thoracotomy approach for aortic valve replacement proved to be easy to perform whilst maintaining the maximum security for the patients.Besides its better cosmetic result especially in female patients, this approach proved to have several advantages.

BACKGROUND The ANTEROLATERAL thigh (ALT) flap is one of the fasciocutaneous flaps in the thigh region based on the septocutaneous or musculocutaneous perforators derived from the lateral circumflex femoral artery (LCFA). This cadaveric study aimed to explore the variability of ALT flap anatomy. METHODS Ten ALT flaps were dissected (2016-20117, Mashhad Legal Medicine Organization) in 10 fresh cadavers (7 males and 3 females). Flaps were marked in a 15 cm area centered on the middle point of a line drown from anterior superior iliac spine to the lateral surface of the patella. Dissection began by searching the skin perforators and then continued along the pathway of the vascular pedicle. RESULTS The average distance of ASIS-Patella was 44. 6 cm. The mean number of skin perforators was 2. 4 (ranged from 0 to 4). In one case, we did not find any skin perforator. The majority of skin perforators were musculocutaneous from descending branch of LCFA (66. 7%) and the remaining were septocutaneous (33. 3%). The mean length of vascular pedicle was 10. 17 cm. The average diameter of vascular pedicle was 2. 78 mm for the artery and 3. 79 mm for the vein. The average time of flap harvesting was 85. 3 min (ranged from 50 to 125 min). CONCLUSION The skin perforators supplying the ALT flap showed significant variability in number, location and course. The cadaveric study could enhance the anatomic knowledge and operative skills of ALT flap harvesting.

Introduction: Hypertrophic cardiomyopathy is the most common genetic heart disease which is described as the thickening of the heart wall and causes abnormal cardiac load. It can be associated with dangerous complications such as heart failure, atrial fibrillation, myocardial infarction and even sudden death. In this study we investigated echocardiographic findings in Hypertrophic cardiomyopathy patients. Methods: In the present study echocardiographic records of 58 patients who were referred to echocardiography clinic of Ghaem hospital between March 2014 and March 2018 were analyzed. After investigation and categorizing the data in echocardiographic recordings, these data were analyzed using SPSS software version 22 and significance level was set as p<0. 05. Exclusion criteria was included patients with suboptimal echocardiography view. Results: The most common hypertrophy phenotype among the patients was ANTEROLATERAL phenotype (44. 8%). In patients with mild and severe left ventricular outlet tract obstruction, 60% of them had ANTEROLATERAL phenotype. Among the patients with mitral regurgitation, in 69. 6% of them the etiology was systolic anterior movement. In the present study 21. 8%, 23. 6% and 20% of patients had mild, moderate and severe left atrial enlargement respectively. Left atrial enlargement severity was significantly associated with the degree of diastolic dysfunction (P<0. 001). Conclusion: As the ANTEROLATERAL phenotype is the most common pattern in patients with hypertrophic cardiomyopathy and associated with more incidence of mitral regurgitation and LV out flow track obstruction, patients with this phenotype need to be evaluated more precisely.

Background: Proximal humeral fracture-dislocations (PHFD) are a special entity in proximal humeral fracture treatment. The aim of this study is to present our minimally invasive plate osteosynthesis (MIPO) technique through an ANTEROLATERAL deltoid split approach. In addition, we performed a retrospective cohort study analyzing the patient reported functional outcome and complications. Methods: A single center cohort study was performed. All patients operated through a deltoid split approach for PHFD between 2009 and 2016 were eligible for inclusion. The primary endpoint was subjective shoulder function measured with QuickDASH and subjective shoulder value (SSV). Secondary endpoints were complications and implant-related irritation. Results: 28 patients were included. The mean age was 49 (SD ± 10. 3). The mean follow-up was 48 months (SD ± 23. 7). The mean QuickDASH score was 6. 8 (SD ± 7. 8) and the mean SSV was 86 (SD ± 14. 6). Four patients had a conversion into a reversed arthroplasty (14%), one patient (4%) a shortening of secondary perforated screws, four patients an early re-osteosynthesis (14%), four patients (14%) developed an AVN and in one patient damage of the axillary nerve was observed. 21 patients (75%) had their implant removed. Conclusion: Patient reported functional results after humeral head preservation and internal fixation of PHFDs through an ANTEROLATERAL deltoid spilt approach are promising. However, there is a high rate of re-operations either because of complications or for implant removal. Comparing our data to literature these rates are not depending on the approach chosen.

We report occurrence of a rare case of Giant Cell Tumor (GCT), in a 28-year old woman, arising from anterior arc of right 6th rib during pregnancy. It progressed rapidly during breast-feeding period, mimicking malignant bone tumor at delayed presentation.

Objectives: The objectives of this study were to compare and analyze the results of right ANTEROLATERAL thoracotomy and median sternotomy approach for primary mitral valve replacement with reference to the exposure during Valve Replacement, length of surgical incision, mean cross clamp time, mean bypass time, intensive care unit (ICU) stay, hospitalization, overall comorbidity with sternotomy; sepsis, dehiscence, healing cosmetic issues and cost effectiveness.Methods: The present study comprised 68 patients with rheumatic mitral valve disease who underwent mitral valve replacement in the Department of Cardiovascular and Thoracic Surgery at Sher-i-Kashmir Institute of Medical Sciences from September 2009 to August 2011.Results: This study comprised 64 patients with 23 (35.9%) males and 41 (64.1%) females. Sternotomy group had 10 males (31.3%) and 22 females (68.7%). Thoracotomy group had 13 males (40.6%) and 19 (59.4%) females. The length of incision between the two groups was statistically significant (P<0.0001). Mean incision length were 24.6±2.1 cm and 14.8±2.3 cm in sternotomy and thoracotomy respectively. Statistically significant difference regarding duration of ICU stay was found between the two groups (P<0.0001). Scar visibility was 100% in sternotomy and around 25% in thoracotomy (P<0.0001).Conclusions: Thoracotomy through a right ANTEROLATERAL aspect was easy to perform while maintaining maximum security for the patients. Besides its satisfactory cosmetic result especially in female patients, this approach proved to have several advantages. It offers a better exposure to the mitral apparatus even in patients with small left, allowing easy mitral valve replacement which is apparent from the lower cross-clamp time in the test group. The invaluable advantage of the above- mentioned thoracotomy is total eradication of the risk of deep sternal infection. The shorter hospital stay and cost effectiveness of thoracotomy approach are additional relief to the family.

Background and Aim: According to previous studies, surgical closure of atrial septal defects (ASDs) was considered as the standard treatment. Two surgical methods, the conventional sternotomy (CSA: median sternotomy) and ante lateral thoracotomy were used. This study was carried out to compare early results of the two techniques in ASD's closure.Materials and Methods: In this descriptive-analytical study from March 1998 to March 2004, the records of 73 patients with ASDs referring to Shahid Madany Hospital - affiliated to Tabriz University of Medical Sciences- were studied. The obtained data were analysed through filling out questionnaires; Fisher, and Mann-Whitney accurate tests were used for statistical analyses at the significant level of P £0.05.Results: Out of 73 patients, 38 cases had undergone thoracotomy (group I); and 35 of them had experienced sternotomy (group II). The difference between mean surgery time in group I (4.33 hours) and in group II (3.43 hours) was significant at P<0.001. Duration of hospitalization between the two groups (10.08 and 12.79 days, respectively)- P=0.01, was significant. There was no significant differences on mean cross-aortic clamping time (32.35 and 35.88 minutes, respectively - P=0.41), mean time of extracorporeal circulation (65.68 and 69.48 minutes, respectively, - P=0.27). Besides, there was no significant difference between the two groups regarding the amount of drainage.Conclusion: Right ANTEROLATERAL thoracotomy for ASD closure can be an appropriate technique, in terms of lower hospitalization days, limited surgical scar and better cosmetic outcome.

BACKGROUND: The role of the ANTEROLATERAL abdominal wall muscles (AAWMs) during the vesical filling and evacuation has not been sufficiently addressed in the literature. We have investigated the hypothesis that the AAWMs exhibit the increased electromyographic (EMG) activity on the vesical distension and contraction which presumably assists vesical evacuation.METHODS: The effects of the vesical balloon distension on the vesical pressure (VP), vesical neck (VNP) pressures and the AAWMs' EMG activity were studied in 28 healthy volunteers aged 40.7±9.7 years (18 men, 10 women). These effects were tested after the individual anesthetization of the bladder and AAWMs and after saline infiltration.RESULTS: The VP and the VNP showed a gradual increase upon the incremental vesical balloon distension which started at a distending volume of 120–140 ml. At a mean volume of 364.6±23.8 ml, the VP increased to a mean of 36.6±3.2 cmH2O, the VNP decreased to 18.4±2.4 cmH2O, and the AAWMs EMG registered a significant increase. This effect disappeared in the individual bladder and in the AAWMs' anesthetization. However, it did not disappear in the saline administration.CONCLUSIONS: The AAWMs appear to contract simultaneously with vesical contraction. This action presumably increases the IAP and it assists vesical contraction. The AAWMs contraction on vesical contraction seems to be mediated through a reflex which is called the 'vesico-abdominal wall reflex'. Further studies are required to investigate the role of this reflex in vesical disorders.