Background: The operation for atrial septal defect (ASD) is considered a low risk procedure; the cosmetic result has become an important feature. For this reason the ANTEROLATERAL thoracotomy is frequently used for closure of ASD. However, difficulty in aortic and caval cannulations to establish cardiopulmonary by pass (CPB) makes it rather awkward for some surgeons.Methods: We reviewed the short term results of a consecutive series of 17 patients in whom the atrial septal defect was closed through a right ANTEROLATERAL thoracotomy.Results: The average cardiopulmonary bypass time was 36 minutes (range 22 to 53 minutes), with mean aortic cross clamp time of 21minutes (range 12 to 44 minutes). There was no preoperative or late mortality. The majority of patients are pleased with their cosmetic results. There were no other late complications. The mean age at operation was 27 years (range 4 to 53 years), and the mean body weight was 51 kg (range 14 to 155 kg). Al the repaired defects were secondum type ASD. Conclusion: Atrial septal defect can be safely repaired through a right anterior thoracotomy approach,with cosmetic results of avoiding median sternotomy.

A 44-year-old woman presenting with a typical history of acute coronary syndrome and ANTEROLATERAL myocardial infarction in electrocardiography underwent primary percutaneous coronary intervention (PCI). After a few days, she complained of motor and sensory loss in her lower extremities. Given her symptoms, signs, and laboratory exams, Guillain–, Barre syndrome (GBS) was diagnosed. Her management was done successfully with therapeutic plasma exchange. Acute myocardial infarction and subsequent PCI might be one of the most uncommon reasons for GBS.

DEAR EDITOR: The radical surgery for fungating inguinal lymph nodes is commonly done in patients with penile and vulvar cancers, creating complex groin defects. These defects are managed most commonly with either pedicled ipsilateral ANTEROLATERAL thigh (ATL) flap or tensor fascia lata (TFL) flap. The reconstruction with complex flaps provide durable coverage and prevent scar contractures, which tend to form in the flexural regions such as the groin.

A rare complication of AMI is papillary muscle rupture (PMR), occurring in 1% of patients with acute myocardial infarction (AMI). Mitral regurgitation related to PMR occurs at a median of 1 day (ranging from 1-14 days) after onset of myocardial infarction. PMR tends to occur in those having a first time AMI and those without extensive collateral circulation. PMR involves posteromedial papillary muscle and ANTEROLATERAL papillary muscle in 75% and 25% of the cases, respectively.We report a 79-year-old man who referred to our hospital with acute severe pulmonary edema. Transthoracic echocardiography showed ruptured ANTEROLATERAL head of papillary muscle resulting in flail anterior mitral valve leaflet and acute severe MR. Patient undergone emergent coronary angiography and we found normal epicardial coronary anteries. The patient was emergently transferred to operating room and MV was replaced with a bioprosthetic valve. He was discharged after one week, feeling well.This study proves the significant role of accurate transthoracic echocardiography in determining the mechanism of acute MR and planning for prompt treatment.

Kawasaki disease occurs across the globe, with Asians being at the highest risk. Approximately, 20% of untreated patients develop coronary artery abnormalities, including aneurysms, and severely affected patients are likely to develop coronary artery thrombosis or stenosis, myocardial infarction, aneurysm rupture, and sudden death.We herein report the case of a 6-year-old boy who developed giant coronary aneurysms, thrombosis, and massive ANTEROLATERAL myocardial infarction despite appropriate treatment for Kawasaki disease, which make this patient a special case.

Background: Atrial septal defect (ASD) operation is a safe and low-risk procedure. Cosmetic results have been an important issue, so right ANTEROLATERAL thoracotomy (RALT) approach has been used for repair. However, in RALT, the skin incision usually crosses the future breast line, which may cause breast mal-development.Method: We reviewed the long-term results of a consecutive series of 406 patients from 1997- 2005 in whom the ASD was closed through a RALT or median sternotomy (MS) incision. 190 patients were male and 216 were female, with a mean age of 8.2±3.9 years. Defects repaired included 383ASD secundum (ASD 20) and 23 ASD sinus venosus type (ASD-SV). In 316 patients (77.8%), the defect was closed through MS, and 90 patients (22.2%) underwent RALT for repair.Result: The mean cardiopulmonary bypass time (CPB time) was 37.0±10 min. for MS vs. 40±11 min. for RALT (p=0.9, NS). Intubation time after operation was 9.0±5 hrs for MS and 8.1±7.1hr in RALT (p=0.8, NS). Postoperative drainage was 119mL (range, 0-1100mL) for MS and 94mL (range, 0-500mL) in RALT (p=0.1, NS). Postoperative pleural/pericardial effusion and pneumothorax occurred in 2.1% of patients in MS and 6.6% in RALT group (p= 0.001). There was no operative or late mortality, morbidity or breast mal-development in the long-term follow-up (range, 6 m -10 y, mean 4 yrs).Conclusion: RALT is a safe and effective alternative approach to MS incision for ASD closure.

A 24 year old otherwise healthy male presented with a chief complaint of giving way in the left knee. MRI reported complete anterior cruciate ligament (ACL) tearing. Arthroscopy showed ACL agenesis, ring-shaped lateral meniscus, and an anomalous thick band extending from the anterior horn of the lateral meniscus to the intercondylar notch of the lateral femoral condyle, which is known as the ANTEROLATERAL meniscofemoral ligament (MFL). The MFL was attached to the anatomic site of anteromedial bundle of ACL. ACL reconstruction surgery was performed using central 1/3 bone tendon bone graft. Practitioners should be aware that ACL reconstruction in lateral meniscofemoral ligament with associated ACL agenesis is a treatment option in which the preservation of MFL, as the stabilizer of anterior horn of lateral meniscus, should be considered during ACL reconstruction.