where first-and second-order cords are attached to the underside of this area. In our case the rough zone was totally covered by the lesions. Operatively, the biggest part of the mass looked like an "active volcano," and the small lesions had a "lava flow" shape (Figure 2). Given this unusual and unexpected diagnosis and the young age of the patient, we opted for exclusive tumor ablation without mitral valve replacement. Although the infiltration of valvular tissue by the PFE is impossible to prove inasmuch as the mitral valve was not extracted, the natural history of this tumor is unknown and preserving the native mitral valve could have been the optimal option. To the best of our knowledge this is the first case of invading PFE on the anterior leaflet of the mitral valve reported in the literature. Clinicians should be aware of this PFE presentation to decide how to manage such patients surgically.

A randomized, controlled trial was conducted to examine the effects of perioperative neuromuscular electrical stimulation on muscle proteolysis and physical function using blinded assessment of physical function. Consecutive patients undergoing cardiovascular surgery were screened for eligibility as study subjects. Participants were randomly assigned to receive either neuromuscular electrical stimulation or the usual postoperative mobilization program. The intervention group received neuromuscular electrical stimulation on bilateral legs 8 times before and after surgery. The primary outcomes were the mean 3-methylhistidine concentration corrected for urinary creatinine content from baseline to postoperative day 6, and knee extensor isometric muscle strength on postoperative day 7. Secondary outcomes were usual walking speed and grip strength. Physical therapists blinded to patient allocation performed measurements of physical function. Of 498 consecutive patients screened for eligibility, 119 participants (intervention group, n = 60; control group, n = 59) were enrolled. In the overall subjects, there were no differences in any outcomes between the intervention and control groups. The results demonstrated no significant effects of neuromuscular electrical stimulation on muscle proteolysis and physical function after cardiovascular surgery, suggesting the need to explore indications for neuromuscular electrical stimulation and to clarify the effects in terms of the dose-response relationship.

Once surgical errors had been ruled out, the 1-year patency rate of proximal saphenous vein grafts anastomosed with the aortic connector system was favorable. Poor left ventricular function and low graft flow during the operation were risk factors for midterm graft occlusion. Selection of the target vessel and its runoff may also be an important determinant of long-term patency.

Giant mobile vegetations on a poorly endothelialized atrial septal defect closure device. CENTRAL MESSAGEGiant mobile vegetations around an atrial septal defect closure device were found on transesophageal echocardiography

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