[Competitive sports activity in subjects undergoing the surgical correction of an ostium-secundum type of interatrial defect: the experience of 9 cases]. / Attività sportiva agonistica in soggetti sottoposti a correzione chirurgica di difetto interatriale tipo ostium secundum: esperienza su 9 casi.

Patients who have undergone surgical repair of congenital heart diseases are usually not allowed to participate in competitive sports. In the present study we report our long-term experience with 9 male athletes aged 17 to 23 years who participate in competitive sports after undergoing surgical repair of ostium secundum atrial septal defect at a median age of 9 years; six of them play football and three of them volleyball. Competitive sport activities began 1 to 5 years after surgical repair. The mean duration of follow-up is 88 +/- 26 months. Sport fitness was granted on the basis of the following criteria: 1) a normal physical examination; 2) a normal working capacity on exercise test; 3) no arrhythmias on exercise test and Holter monitoring, recorded also during sport activities; 4) a normal M-mode and two-dimensional echocardiography, including the normalization of right ventricular size; the persistence of an abnormal ventricular septal motion did not exclude sport fitness. Recently we also performed Doppler and color Doppler echocardiography and gated equilibrium radionuclide angiography at rest and during exercise. We studied left ventricular diastolic filling through the pulsed wave Doppler evaluation of transmitral flow and measured cardiac output by continuous wave Doppler echocardiography during exercise test in the supine position. We also performed exercise test and M-mode, two-dimensional, Doppler and color Doppler echocardiography in a control group made up of 15 athletes (10 football players and 5 volleyball players). The exercise duration at graded treadmill exercise test (according to the Carù protocol), the maximal heart rate and the maximal systolic blood pressure were, respectively, 12.9 +/- 0.8 min, 192 +/- 10 beats/min and 198 +/- 12 mmHg. Left ventricular end-diastolic dimension, mass and ejection fraction (single-plane area-length method) were 50.3 +/- 2.8 mm, 210 +/- 38 g and 65 +/- 6%. M-mode right ventricular diastolic dimension was 23.4 +/- 1.6 mm; the right ventricular maximal diastolic diameter and area obtained on two-dimensional echocardiography from the apical four chamber view were 44.1 +/- 3.6 mm and 25 +/- 3.8 cm2 respectively. The evaluation of transmitral flow showed the following data: E velocity 77 +/- 12 cm/sec, A velocity 45 +/- 6 cm/sec, E/A ratio 1.7 +/- 0.3, the isovolumic-relaxation period 72 +/- 8 m/sec and the deceleration half-time of the early rapid filling 71 +/- 10 m/sec. A trivial tricuspid regurgitation was detected in 6 subjects; the peak velocity of the regurgitant jet was less than 2.1 m/sec.(ABSTRACT TRUNCATED AT 400 WORDS)

[Aortic coarctation surgically treated in the 1st year of life. Results in 36 cases]. / La coartazione aortica operata nel primo anno di vita. Risultati in 36 casi.

Thirty-six infants under one year of age underwent surgical repair of coarctation of the aorta between 1968 and 1983 in our institution. Coarctation was isolated or associated to a patent ductus arteriosus in sixteen cases, while in twenty it was associated with significant intracardiac disease. Twenty-nine patients were operated on in the first three months of life and in twenty a severe heart failure was present before the operation. Nine patients (25%) died while in the hospital: all of them were less than three months of age and all but one were affected by major intracardiac anomalies and severe heart failure. Surgical repair was by subclavian flap aortoplasty in twenty-nine cases, resection with end-to-end anastomosis in three, patch aortoplasty in three and Blalock-Park anastomosis in one. Operative mortality was unaffected by the surgical technique. The surviving children were followed-up for 30 +/- 7 months; one late death occurred suddenly, two months after the repair of a ventricular septal defect. An arm/leg pressure gradient, indicative of recoarctation, was detected in five cases: only one had been repaired by the subclavian flap technique, while the others were the only survivors of the end-to-end anastomosis and patch aortoplasty group. Subclavian flap aortoplasty is suggested as the operation of choice for coarctation of the aorta in the first year of life.

[Long-term therapy with oral prazosin in chronic congestive heart failure: a clinical and echocardiographic evaluation (author's transl)]. / Effetti della somministrazione protratta di prazosina nella terapia dello scompenso cardiaco congestizio cronico. Valutazione clinica ed ecocardiografica.

Eight patients, ranging in age from 20 to 61 years (48 +/- 11 years, mean +/- 1 SD), with chronic heart failure due to idiopathic congestive cardiomyopathy (5 cases), ischemic heart disease with healed anterior myocardial infarction (2 cases), and rheumatic heart disease with a Björk-Shiley mitral valve prosthesis (1 case), received longterm therapy with oral prazosin in increasing doses (mean final dose: 26 +/- 6 mg/day). Administration of digoxin and diuretics were continued throught the study period (range: 21-228 days). All but one patient showed no functional improvement during the period of prazosin therapy (2 patients in New York Heart Association functional class IV, 5 patients in III class). One patient, the youngest of the group, who initially had class IV heart failure, showed improvement to III class after a 26 days administration of this vasodilator. Prazosin caused no consistent change in systemic arterial pressure, heart rate, cardio-thoracic ratio, and radiologic pulmonary venous stasis. Occasionally, on chest X-ray, a patient showed a transitory decrease of cardiomegaly and/or pulmonary venous congestion. P and QRS waves of ECG showed no evident change, as did serum creatinine and billirubin levels. On serial M-mode echocardiographic analyses, left ventricular minor axis dimension, ejection, and left atrial size showed no statistically significant change from pre-treatment averages of: 7.5 +/- 0.9 cm, 0.36 +/- 0.14, 4.9 +/- 1.3 cm, respectively. At late follow-up some indices of left ventricular performance showed a definite tendency to decrease: fractional shortening of the minor axis from 18.9 +/- 9.1 to 17.0 +/- 7.0, mean velocity of circumferential fiber shortening from 0.79 +/- 0.28 sec-1 to 0.69 +/- 0.28 sec-1, mean normalized systolic ejection velocity from 1.58 +/- 0.44 sec-1 to 1.47 +/- 0.39 sec-1, and mean normalized posterior wall velocity from 0.55 +/- 0.3 sec-1 to 0.49 +/- 0.18 sec-1. Prazosin in patients with chronic congestive failure due to cardiomyopathies, does not elict a persistent improvement of resting hemodynamics because of the development of pharmacodynamic tolerance in the majority of the patients. Prazosin, furthermore, does not improve the depressed myocardial contractility that necessarily affects the long-term prognosis of these patients.