Objective-To assess the immediate haemodynamic improvement and long term symptomatic benefit of percutaneous mitral balloon valvotomy in patients aged over 70 years. Design-Pre-and postprocedure haemodynamic data and follow up for 1 to 10 years by clinic visit or telephone contact. Setting-Tertiary referral centre in Scotland. Subjects-80 patients age 70 and over who had mitral balloon dilatation: 55 were considered unsuitable for surgical treatment because of frailty or associated disease. In an additional four patients mitral dilatation was not achieved. Main outcome measures-Increase in valve area after balloon dilatation and survival, freedom from valve replacement, and symptom class at follow up. Results-Mean (SD) valve area increased by 89% from 0.84 (0.28) to 1.59 (0.67) cm 2 . There was a low rate of serious complications, with only two patients having long term major sequelae. Of 55 patients unsuitable for surgical treatment, 28 (51%) were alive without valve replacement and with improvement by at least one symptom class at one year, and 14 (25%) at five years. In the 25 patients considered suitable for surgical treatment, 16 (64%) achieved this outcome at one year and nine (36%) at five years. Conclusions-Percutaneous mitral balloon valvotomy is a safe and useful palliative procedure in elderly patients who are unsuitable for surgery. Balloon dilatation should also be used for elderly patients whose valve appears suitable for improvement by commissurotomy, but echo score is an imperfect predictor of haemodynamic improvement. (Heart 2000;83:433-438)

No abstract

Recanalization of previously coiled aneurysms remains a major drawback of endovascular aneurysm therapy. We performed a prospective single arm trial to provide early initial data regarding the safety and angiographic durability of a new coil technology, the Axium MicroFX Polyglycolic/polylactic acid (PGLA) coil, which was designed to lower recanalization rates. Fifteen patients (16 aneurysms) were prospectively enrolled. Demographic and peri-procedural data were collected. Angiographic images of the initial coil embolization and three to six month follow-up angiographic images underwent blinded evaluation. Seven (47%) SAH and eight (53%) elective patients were enrolled. Blinded evaluation of the initial embolization demonstrated that 5/16 (31%) aneurysms achieved Raymond grade 1, 5/16 (31%) grade 2 and 6/16 (38%) grade 3. Three to six month angiography was obtained in 12/15 patients (80%); two patients expired (1 SAH, 1 elective) and one was lost to follow-up (SAH). All patients who underwent follow-up angiography had a mRS ≤1. Blinded evaluation of embolization demonstrated 7/13 aneurysms (54%) improved in Raymond grading, five (38%) were stable and one aneurysm (8%) worsened. One patient developed an asymptomatic peri-aneurysmal parent vessel stenosis. Axium MicroFX coils appear to be safe, though the small number of patients in this series obviates comparative analysis with other series. Further studies are needed with more patients to compare the angiographic durability of Axium MicroFX coils to other coils.

Correspondencelocal resection. With the aid of endoscopic retrograde cholangiopancreatography and careful histological grading a more accurate definition of the role of local resection should emerge. Finally, all three studies appear to show that bypass surgery has no part to play in the management of these lesions. R. A. Knox R. D. KingstonPark Hospital Manchester U K 1. 2. Underwood CJ, Faragher EB. The uses and abuses of life-table methods in vascular surgery. Br J Surg 1984; 71: 495-8. Knox RA, Kingston RD. Carcinoma of the ampulla of Vater. Br J Surg 1986; 73: 72-3.

A case of ruptured common iliac artery aneurysm is reported. The patient presented with a perianal hematoma and had undergone repair of a leaking abdominal aortic aneurysm seven years previously. The presentation and management are discussed.