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176 CORRESPONDENCE Ann Thorac Surg 1991;52:175-6 3. Nakahara K, Ohno K, Hashimoto J, et al. Thymoma: results with complete resection and adjuvant post-operative irradia- tion in 141 consecutive patients. J Thorac Cardiovasc Surg 1988;95:1041-7. 4. Sartori F, Rea F, Calabro F, Fornasiero A, Daniele 0. L'ap- proccio chemio-chirurgico nel timoma maligno. 21st Congress of the Italian Society of Thoracic Surgery. Rome, May 2528, 1988:lOM. Mitral Valve Replacement by Twin Starr Prostheses To the Editor: In 1977, when he was 26 years old, a patient with Marfan syndrome had treatment of an acute aortic dissection by replace- ment of the ascending aorta by a Dacron tube, aortic valve replacement by a Bjork-Shiley prosthesis, and reimplantation of the coronary ostia in the tube. He was examined again when he was 38 years old and was found to have mitral insufficiency. Catheterization confirmed the existence of a huge dilatation of the left atrium; the valve was totally incompetent, and the functional status was worsening. We decided to replace the mitral valve. When the left atrium was opened during the operation, the mitral valve appeared extremely damaged with a degenerative appearance, rupture of the chordae tendineae of the small valve, and calcification of the annulus. The valve was excised, leaving an orifice in which one could put four fingers; the largest dimension of the orifice was measured at 80 mm. In such conditions, it was decided to place a particular type of prosthesis made of two 5M Starr valves linked one to the other, the two anterior and posterior "trigones" being closed with two triangu- lar pieces of Teflon felt, making the prosthesis strictly ovalus (Fig 1). The operation then went on in a routine fmhion. With the patient off bypass, monitoring of the pressure simultaneously in the left atrium, left ventricle, and ascending aorta showed no gradient at all through the mitral prosthesis. The patient was followed up clinically and radiologically (Fig 2). Functioning of the prosthesis was examined with fluoroscopy Fig 1. The prosthesis, constructed of two Starr 5M values ventricular cavity, without compromising the ejection chamber of the left ventricle. 1. Iotirdan 1. Teboul 1. M. Grinda Ch. Isetta Department of CardioVascular Surgey Hbpital Pasteur 30 aue de la Vole Romaine France 06002 Nice CKdKX and with transesophageal echocardiography. No dysfunction was noted, no gradient was measurable, and the functioning of the two balls was totally synchronous. There is no evidence of biological or hematological signs of particular consumption of anticoagulants or any other effect of the balls on the red cells. The original procedure appeared to us mandatory because of the unusually huge size of the mitral annulus. Plastic surgery of the valve or use of any kind of reduction technique on the annulus was not thought possible, given the size of the left Fig 2. Chest roentgenogram of the patient after placement of the two- valve prosthesis. CORRECTION "Growth of Tracheal Anastomoses: Advantage of Ab- sorbable Interrupted Sutures" by Peter P. McKeown, FRCS(C), FRACS, Hidetoshi Tsuboi, MD, Takao Togo, MD, Robert Thomas, BA, Richard Tuck, BA, and David Gordon, MD (Ann Thorac Surg 1991;51:63641) Figures 3b and 4b of this article were inadvertently interchanged. The Annals regrets the error.
