Giornale italiano di cardiologia
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A case of severe tricuspid insufficiency with ruptured chordae tendineae due to nonpenetrating major chest trauma caused by a car accident is described. Electrocardiographic signs of complete right bundle branch block and olosystolic murmur were present and not observed before. Transthoracic echocardiography showed a significant prolapse of the septal tricuspid leaflet with severe tricuspid regurgitation and severe right heart overload, which progressively worsened. ⋯ Although the patient remained asymptomatic, these findings prompted us to refer the case to the surgeon. The patient underwent valvuloplasty with excellent late result. In presence of traumatic tricuspid insufficiency the use of transesophageal echocardiography can be helpful to optimize the anatomic evaluation of the valvular apparatus allowing adequate therapeutic decision.
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Two women suffered from aortic dissection during the third term of pregnancy. The first one, 37 years old, died from a sudden and intractable cardiovascular shock at the end of pregnancy, but the fetus was saved by cesarean. ⋯ In the second case a faster diagnosis and a slower development of the aortic dissection allowed, during the 29th week of pregnancy, a surgical treatment after cesarean saving both the mother's and newborn's life. The histological examination in both cases showed only non specific alterations of the collagenous and the elastic fibres.
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Surgical repair is the procedure of choice for atrial septal defect correction. Even though surgical mortality is low (< 1%), morbidity is significant (anesthesia, thoracotomy, cardiopulmonary bypass, longer hospitalization and intensive care unit monitoring). Transcatheter methods to occlude atrial septal defects have been in development during the last two decades. We report our experience in Italy with the Sideris buttoned double-disk device. ⋯ This initial experience with the Sideris buttoned double-disk device demonstrated that transcatheter closure of atrial septal defect is feasible and effective. It can be accomplished through small introducing sheaths. Further clinical trials are justified. This method could become the procedure of choice for the correction of small ASDs.
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The authors report the case of a 38-year-old woman with acute influenza myocarditis, cardiogenic shock and multiorgan injuries. The echocardiogram showed symmetric thickening and severe hypokinesis of the ventricular wall, with a concomitant reduction of the left ventricular cavity due to myocardial edema and cellular infiltration. ⋯ The myocarditis resolved without sequelae. The hemodynamic implications of this transient myocardial thickening and its relationship to steroid therapy are discussed.
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Case Reports
[Anomalous origin of the right coronary from the left sinus of Valsalva. A possible cause of juvenile sudden death].
Anomalous origin of the right coronary artery from the left sinus of Valsalva is a rare congenital anomaly classified as a "minor" anomaly of no clinical importance. Recently, manifestations of myocardial ischemia (angina pectoris, myocardial infarction, nonfatal ventricular fibrillation, sudden death) have been described in patients with this anomaly in the absence of atherosclerosis or other. Sudden death occurs frequently in symptomatic patients and rarely in asymptomatic patients (sudden unexpected death). ⋯ In case 2 the coronary anomaly was connected to other cardiac and non cardiac diseases (lymphocytic active myocarditis, chronic portitis, encephalitis, medullary adrenalitis). Since these morphologic lesions were extremely slight and there was no adrenal catecholamine damage in the myocardium, we consider negligible their possible role in determining death, which in this case was induced by the congenital coronary anomaly. The cardiac microscopic findings, also in this case, revealed ischemic lesions in the myocardium supplied by the anomalous right coronary artery.(ABSTRACT TRUNCATED AT 250 WORDS)