[Transesophageal echocardiography in dynamic obstruction of left ventricular outflow after mitral valve surgery]. / Ecocardiografia transesofagea (TEE) nella stenosi dinamica dell'outflow ventricolare sinistro secondaria ad intervento riparativo della valvola mitrale.

The authors report a case of dynamic obstruction of the ventricular outflow due to mitral valve surgery (valvuloplasty) in a 70-year-old woman with posterior leaflet mitral prolapse and severe regurgitation associated with anomalous implant of the posterior papillary muscle and increased thickness of the basal interventricular septum. Mitral valve surgery, possible for isolated prolapse of the LPM, although myectomy of the SIV has been performed, has determined onset of a systolic anterior motion (SAM), responsible of the dynamic obstruction. The diagnosis by means of transesophageal echocardiography (TEE) of the secondary SAM has allowed to optimise therapy (suspension of the inotropic drug, increase of volemia) with rapid improvement of hemodynamic conditions and in the following controls at is possible to observe a remodelling of the left ventricular geometry with pressure gradient reduction.

Early percutaneous endoscopic gastrostomy (PEG). A safe and effective enteral feeding technique in neurologic intensive care unit.

Enteral feeding by percutaneous gastrostomy is recommended as the "best choice" in NICU patients. It allows us to obtain early gut activation and to prevent physiopathologic events leading to multiorgan failure syndrome. In this retrospective study the Authors describe their experience related to 76 patients admitted in NICU between January 1992 and April 1994. In these patients percutaneous gastrostomy was easily and safety performed at the bedside with early enteral nutrition and drug administration and a related low incidence of infections complicating central and peripheral vein catheterization. Moreover the authors underline the avoidance of nasogstric tube and its side effects and a good compliance of patients and nurses that seems to be a real advantage of this technique. The authors suggest their 13 guidelines to improve management of enteral nutrition by gastrostomy and to avoid its short-comings.