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Objectives: To evaluate a new surgical technique for the correction of anterior mitral leaflet prolapse., Methods: From October 2006 to November 2011, 44 consecutive patients (28 males, mean age 55 ± 13 years) underwent mitral valve repair because of anterior mitral leaflet prolapse. Echocardiography was performed to evaluate the distance from the tip of each papillary muscle to the annular plane. A specially designed caliper was used to manufacture a parachute-like device, by looping a 4-0 polytetrafluoroethylene suture between a Dacron strip and Teflon felt pledget, according to the preoperative echocardiographic measurements. This parachute was then used to resuspend the anterior mitral leaflet to the corresponding papillary muscle. Of the 44 patients, 35 (80%) required concomitant posterior leaflet repair. Additional procedures were required in 16 patients (36%). The preoperative logistic European System for Cardiac Operative Risk Evaluation was 4.3 ± 6.9., Results: The clinical and echocardiographic follow-up were complete. The total follow-up was 1031 patient-months and averaged 23.4 ± 17.2 months per patient. The overall mortality rate was 4.5% (n = 2). Also, 2 patients (4.5%) with recurrent mitral regurgitation required mitral valve replacement, 1 on the first postoperative day and 1 after 13 months. In the latter patient, histologic analysis showed complete endothelialization of the Dacron strip. At follow-up, all non-reoperated survivors (n = 40) were in New York Heart Association class I, with no regurgitation in 40 patients (93%) and grade 2+ mitral regurgitation in 3 (7%)., Conclusions: This technique offers a simple and reproducible solution for correction of anterior leaflet prolapse. Echocardiography can reliably evaluate the length of the chordae. However, the long-term results must be evaluated and compared with other surgical strategies., (Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)

Peritoneal fossae derive from normal or anomalous coalescence of the peritoneum during fetal development, or from the course of retroperitoneal vessels. Clinically, internal abdominal hernias may be housed inside these fossae. In this report from an autopsy, a singular peritoneal fossa was delimited superiorly by an arcuate serous fold, raised up by the inferior mesenteric vein, and infero-posteriorly by two (right and left) avascular folds, extending from the abdominal aorta to the jejunum. The right fold reached the duodeno-jejunal flexure, which was located on the right side of the aorta. The left fold subdivided into two, anterior and posterior, secondary folds. The anterior fold reached the superior edge of the first jejunal loop, and the posterior fold turned medially to connect with the inferior edge of the proximal limb of the same loop. This fossa consisted of three recesses: superior, Located behind the subserous vascular arch, antero-inferior and postero-inferior, separated by interposition of the left posterior secondary fold, between the jejunum and aorta. The complex arrangement of this fossa suggests that it might have originated from a coalescence arising beyond the duodeno-jejunal flexure and including the first jejunal loop, and from the subserous course of the inferior mesenteric vein. Because of displacement to the right of the flexure, processes of coalescence in a location normally occupied by the ascending duodenum might have occurred in a similar pattern for the jejunum, involving the mesoduodenum and the proximal part of the mesentery. Labyrinthine fossae like this might cause strangulation of internal abdominal hernias and hinder intraoperative maneuvers.

After dissection of the abdominal cavity of a 59-year-old male, a long artery, extending from the hepatic artery to the transverse colon, and comprised proximally within the neck of the pancreas and distally within the transverse mesocolon, has been detected. This "pancreato-colic" artery (P-C A) was 13 cm in length and 4 mm in diameter at the origin. Its mesocolic part (2.5 mm in diameter) contributed to the formation of the marginal arcade. No middle colic artery from the superior mesenteric was observed. Thus, the transverse colon was supplied by the distal part of the P-C A. Considering both the P-C A caliber and topography, attention should be paid during pancreatic resections and in the interposition of the transverse colon for esophageal replacement in order to avoid serious bleeding and necrosis. Embryologically, the proximal part of the P-C A might be regarded as an intrapancreatic variant of the tract of the longitudinal anastomosis between the ventral segmental arteries, persisting in the adult as dorsal pancreatic artery. Different from its usual retropancreatic location, this part might be entrapped inside the gland by the developing primitive pancreatic anlages. The distal, mesocolic, part of the P-C A might be regarded as a replacing middle colic artery into the dorsal mesentery during midgut rotation.