Giornale italiano di cardiologia
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The present study summarizes our ten-year (1985-1995) experience with endomyocardial biopsy (EMB) in patients with idiopathic congestive heart failure (CHF), with specific reference to frequency of myocarditis, treatment policy, relative benefits, and follow-up. Of the 601 patients who constituted our series, 38 were clinically suspected of having myocarditis on the bases of a very recent onset of congestive heart failure and/or of arrhythmias and/or of conduction disturbances, and of a close-to-recent history of flu-like febrile illness. Corresponding EMBs showed myocarditis in 16 of the 38 cases (42.1%). ⋯ Of the 20 overall patients who died, 12 were originally in NYHA class IV, 6 in class III, 2 in class II; of the 8 patients who underwent transplantation, 6 were originally in NYHA class IV and 2 in class III. Our overall experience shows that the frequency of myocarditis diagnosed according to Dallas criteria is high in patients with clinical diagnosis of myocarditis, while it is extremely low in dilated cardiomyopathy patients. This finding suggests that, although non-specific, recent onset of symptoms and prior febrile infe
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Neonatal arterial one-stage switch operation (ASO) for transposition of the great arteries (TGA) is currently the procedure of choice for TGA. There is a potential risk of myocardial damage related to coronary artery reimplantation and sudden pressure overload imposed on the left ventricle after discontinuation of the cardiopulmonary bypass. ⋯ In conclusion in children undergoing neonatal ASO for TGA with intact septum or ventricular septal defect, evaluated after a mean post-surgical follow-up of 2 years, systolic and diastolic performance of the left ventricle was normal. Regional wall motion abnormalities with slightly reduced septal motion were detected in 5 cases. The reason for the small increase in mass index is unknown. The slight reduction of the preload is related to the routine drug therapy in the patients studied early after surgical repair.
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This study compares the mitral valve area determined by Doppler color mapping of the proximal isovelocity surface area (PISA) and by Doppler pressure half-time with that obtained by two-dimensional planimetry in patients affected by mitral stenosis, with and without associated aortic regurgitation. Pressure half-time frequently overestimates the mitral valve area in patients with mitral stenosis and associated aortic regurgitation. PISA is an alternative method for determining mitral valve area in mitral stenosis and is not influenced by regurgitant lesions. ⋯ In patients with mitral stenosis and significant aortic regurgitation, the PISA method is more accurate than pressure half-time in assessing mitral valve area. This method may be a reliable alternative when pressure half-time is affected by aortic regurgitation and two-dimensional planimetry images are unsuitable for anatomic evaluation.
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Clinical Trial
[Three-dimensional transesophageal echocardiography: a new cardiologic diagnostic tool. Initial experience with 150 patients].
Three-dimensional transesophageal echocardiography is a new diagnostic tool and its potential has been investigated mainly in international centers dealing with research in the field of cardiac pathologies. The clinical usefulness and the potential additional information over multiplane transesophageal echocardiography in daily clinical practice have not been exstensively studied. ⋯ The diagnostic use of the transesophageal technique with 3 D facilities permitted to obtain an overall 22% of additional information. These results will stimulate further study to evaluate the advantages of the three-dimensional technique in specific clinical fields of application.
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Various surgical techniques have been used for correction of Ebstein's anomaly. This paper reports our early and intermediate term results for repair of this disease using the technique initially employed by Carpentier. ⋯ Repair of Ebstein's anomaly, using the technique reported by Carpentier, can be accomplished with an acceptable operative risk and satisfactory intermediate term results. Echocardiography has an important role in the diagnosis of Ebstein's anomaly as well as in the indications and timing for repair and it is particularly useful for intra- and postoperative monitoring and anatomofunctional evaluation.