Methods: Since 1998, a great deal of innovation has contributed to establishing

mitral valve repair via right minithoracotomy as a routine surgical approach for mitral valve insufficiency in 252 cases. During the last 2 years, a newly launched left atrial retractor system attachable to the minithoracotomy spreader has been used. An additional retractor for the posterior wall of the left atrium was attached to the minithoracotomy spreader. The retractor moves flexibly and can be fixed in any favorable position to realize optimal exposure of the mitral valve. A 5 blade size was available depending on the left atrial size and target legion. By using the smallest size, even papillary muscles were exposed 3 easily and clearly. Furthermore, a flexible silicon ring sizer, which could easily pass thorough a narrow working port without tissue damage, was used for sizing the

annuloplasty ring. For the surgical technique, multiple chordal reconstructions by the loop technique with polytetrafluoroethylene (Gore-Tex CV-5 sutures) were applied. A reusable clip for fixing knots made it easy to tie the Gore-Tex suture in the correct position without slipping.

Results: No operative mortality occurred. There were 2 conversions to sternotomy for correction of aortic dissection (1) and for coronary artery bypass grafting (1). There were 2 early reoperations for failure of mitral valve repair.

The mean aortic crossclamp time was 163.5 +/- 41.6 minutes. Annuloplasty with a ring or band was performed in all cases except one. The loop technique was used in 173 cases. Among them, a combination of the loop technique and resection and suture technique was used in 56 cases.

Conclusions: Newly innovated mini-mitral valve surgical instruments and techniques facilitate both direct-vision and endoscopic-assisted approaches and accomplish a favorable surgical outcome even in the complex pathology of mitral valve insufficiency. (J Thorac Cardiovasc Surg 2012;143:S82-5)”
“Neuroimaging studies have revealed gray matter abnormalities in schizophrenia in various regions of the brain. It is, however, still unclear whether such abnormalities are already present in individuals at ultra-high risk (UHR) for transition into psychosis. We investigated this issue using voxel-based morphometry of structural magnetic resonance images (MRI) and compared UHR patients with first-episode patients with schizophrenia and healthy controls. Gray matter volume maps from high-resolution MR T1-weighted whole brain images were analyzed in a cross-sectional study in 30 UHR patients, 23 first-episode schizophrenic patients and 29 controls.