No abstract

Asymmetrical joint geometry is common and causes asymmetrical joint dynamics. Thus, a clinician attempting to palpate vertebral motion would be misled by assuming that perceived restricted joint motion universally represented a finding potentially amenable to manipulation. For spine palpation to be a valid indicator for manipulation, the clinician applying it must first be able to differentiate between asymmetrical motion caused by vertebral fixation and that caused by asymmetrical joint anatomy.

Aortic root enlargement with a patch is sometimes indicated either to prevent aortic homograft valve distortion during implantation or to facilitate easy, tension-free closure of the aortotomy. Patches made of prosthetic material have been widely used for this purpose. The use of autogenous pericardium has recently been reported. Although dura mater has been shown to have great strength, low antigenicity, athrombogenicity, easy availability in large sizes and rapid bonding to most tissues, its use for patch enlargement of the aortic root has not been previously documented. From 1979 to 1983, 38 patients had dura mater aortic root gussets placed during aortic valve replacement at the Southampton General Hospital. In all cases, the patches were placed to facilitate aortic closure, or to prevent homograft valve distortion by enlarging the non-coronary sinus. Aortic homografts were implanted in 11 patients, Carpentier Edwards' Xenograft valves in 16, Björk-Shiley valves in 8 and Wessex Xenografts in 3 patients. All the patients survived and in a mean follow-up of 30 +/- 12.8 months (range 3 to 48 months) there has been no clinical evidence of patch failure due to leakage, rupture or aneurysm formation. These results suggest that glycerol-preserved dura mater is a satisfactory patch material for aortic root enlargement during aortic valve replacement.

Two reports of the rare condition, acquired aorto-pulmonary fistula, are presented, one the result of acute aortic dissection, the other, giant cell aortitis. The presentation, diagnosis, and management are discussed and the literature reviewed.

When assessing the function of the mitral valve at operation by palpation or inspection, the surest way to prevent systemic (cerebral) embolism is to have the ascending aorta occluded by a clamp.A technique is described which allows safe assessment of mitral valve function by aortic root and left ventricular perfusion, giving a beating-heart preparation with the aorta cross-clamped.This method has been in successful use for more than two years and has been found particularly useful in the accurate repair of cleft mitral valves in atrioventricular defects (ostium primum defects and atrioventricular canal).