[Basal left anterior oblique projection in 2-dimensional echocardiography: its usefulness in defects of the atrioventricular septum]. / La sezione obliqua anteriore sinistra basale in ECO 2D: utilità nei difetti del setto A-V.

The defects of the A-V septum have been recently classified into classes with separate orifices and classes with common orifice on the basis of the presence or not of a tissue tongue which joins the two bridging anterior and posterior leaflets as single differential feature. The diagnostic usefulness of the subxiphoid projection by conventionally called left oblique anterior basal has been evaluated. It indicates in a single plan-section the two bridging leaflets together with the connecting tongue. In 18 cases of defect of A-V septum echo-angiographic correlation was made. The 2D-echo diagnosed in 10 cases a defect of A-V septum with common orifice and in 8 cases a defect of A-V septum with separate orifices. On the contrary the angiocardiography pointed out in 9 cases a defect of A-V septum with separate orifices. Ten of the eighteen patients examined underwent an operation, which has always confirmed the echocardiographical diagnosis; even in the unique case of echo-angio disagreement the diagnosis of 2D-echo was confirmed. Therefore we propose the above-mentioned projection in order to obtain a more accurate non invasive definition in the defects of A-V septum.

[10-year survival after myocardial infarction. Longitudinal study of a hospital population]. / Sopravvivenza a 10 anni dopo l'infarto del miocardio. Studio longitudinale su una popolazione ospedaliera.

In this study, 321 patients discharged from hospital after an acute myocardial infarction were followed for 10 years or until death. Death rate was 46.4% and 30.8% of all fatalities was sudden. In over 80% of the cases death was from cardiac causes and frequently occurred out of hospital. Univariate analysis showed that age, female sex, previous infarction, diabetes, heart failure during hospitalization, heart murmur, NYHA class III or IV, post-infarction angina, intraventricular conduction defects, cardiomegaly, ST displacement, were all associated with an increased death rate. A positive exercise test 6-17 months after infarction, was associated with a 4-fold mortality increase. Bypass played a minor role in this series since only 6.8% of the patients underwent this operation. A nonfatal infarction recurred in 71 patients (22.1%) with an annual rate of 2.2%. Annual death rate after the first 2 years of follow-up was 3.9%, as in most recent reports on survival after myocardial infarction.

[Tetralogy of Fallot. Subcostal approach in bidimensional echocardiography]. / Tetralogia di Fallot. Approccio sottocostale in ecocardiografia bidimensionale.

We have evaluated the diagnostic accuracy of subxyphoid 2-dimensional (2-D) echocardiography in Fallot's tetralogy by employing two planes defined as left anterior oblique (LAO) and right anterior oblique (RAO), similar to the respective angiographic axial projections. Echocardiographic and angiographic findings were compared in 39 patients. The pulmonary branches, the trunk, the infundibulum, the septal defect and the aorta were identified in all cases, the pulmonary valve in 97% and associated defects in 71%. The LAO view was best suited for an overall diagnosis and for the visualization of the left pulmonary branch, of the pulmonary anulus, and of the overriding of the aorta. The RAO proved optimal for the evaluation of the right pulmonary branch, of the infundibulum and of the relationship between ventricular septal defect and adjacent structures. It is concluded that the subxiphoid approach is a valuable technique for the 2-D echocardiographic evaluation of Tetralogy of Fallot.

[Balloon occlusion aortography in the angiographic study of pulmonary atresia with interventricular defect]. / L'aortografia con occlusione nello studio angiografico dell'atresia polmonare con difetto interventricolare.

Balloon aortography is a new technique for the angiographic study of pulmonary atresia with ventricular septal defect. A Swan-Ganz angiographic catheter is employed, whose balloon is inflated to stop blood flow in the descending aorta, thus ensuring the opacification of the pulmonary circulation. By this method we have studied 18 patients. Anatomic details of the pulmonary arterial circulation were obtained in all. No complications occurred. Balloon aortography is a simple and safe technique for the routine study of patients with pulmonary atresia and ventricular septal defect, whereas selective injection in collateral arteries or pulmonary veins, which carries more risk and is more complex, should be adopted only in selected cases.

[Prevalence of hyperkinetic arrhythmias in a healthy infantile and adolescent population: correlations between standard ECG, stress test and dynamic ECG]. / Prevalenza di aritmie ipercinetiche in una popolazione infantile e adolescente sana: correlazioni fra ECG standard, prova da sforzo ed ECG dinamico.

We evaluated 250 males and 250 females 4 to 17.99 years old, randomly recruited among school-children. Cardiac and other diseases were excluded. All the subjects were studied with a standard ECG iun the standing and supine position for a minute. Three hundred children underwent a treadmill exercise test according to Bruce's protocol and 50 of them had a 24-hour ambulatory ECG monitoring. Sinus arrhythmia was present in 94% of the children in supine position and in 87% of them while they were standing. Only one child had atrial and ventricular premature beats. In a boy a slow ventricular tachycardia was recorded. One child had a WPW and a girl a short PR interval; both were asymptomatic. The exercise test did not induce any arrhythmias and the slow ventricular tachycardia, in the previously mentioned boy was suppressed during exercise and reappeared during the recovery period. The premature beats were greatly reduced in the child who had them during the standard ECG recording. The 24-hour ambulatory ECG monitoring showed only minor degrees of premature atrial and ventricular beats in 24% of the children studied by this method. The maximum number of premature beats was 39 in 24 hours and never exceeded the first grade of Lown's classification. We conclude that a good correlation exists among the three employed techniques in the study of the prevalence of tachyarrhythmias in healthy children. This is the first study that compares these three techniques in a pediatric population.

[Straddling and overriding atrio-ventricular valves: echocardiographic and angiographic findings]. / Valvole atrio-ventricolari cavalcanti. Rilievi ecoangiocardiografici.

Recent advances in surgical technique for correction of positional abnormalities of atrio-ventricular (A-V) valve require accurate preoperative diagnosis of this malformation which can be distinguished into a complete (overriding + straddling) and a partial form (overriding or straddling). In this study, echocardiography and angiocardiography are shown to be complementary to each other for definition of the anatomic details of this pathology. Six cases of positional abnormalities of the A-V valves are reported. Group I includes three patients with tricuspid valve abnormalities: two are complete forms (overriding + straddling) one of which is associated with DORV and the other is associated with d-TGA. The third patient is a partial form: straddling tricuspid valve with only a large ventricular septal defect involving the inlet septum. Group II includes three patients with mitral valve abnormalities: one complete form and two partial ones (straddling), all associated with DORV. We illustrate the best echocardiographic and angiocardiographic projection for the recognition of A-V valve malposition and demonstrate that both techniques greatly add to the diagnostic accuracy. Echocardiography defines better the abnormal attachments of the leaflet apparatus, whereas angiocardiography identifies better the displacement of the A-V valve annulus.

[Electrocardiographic and vectorcardiographic examinations in differential diagnosis of cyanotic congenital cardiopathies with interventricular defect and obstruction of pulmonary outflow]. / L'esame elettrovettorcardiografico nella diagnostica differenziale delle cardiopatie congenite cianotiche con difetto interventricolare ed ostruzione all'efflusso polmonare.

The value of the electrocardiogram and vectorcardiogram for the diagnosis of congenital heart diseases with VSD and pulmonary obstruction is illustrated. Three types of electrocardiographic pattern are encountered: 1) pressure overload to the right ventricle (Tetralogy of Fallot, DORV, TGA); 2) left ventricular hypertrophy (TA, UH with outlet chamber to the right); 3) Inversion of septal activation (Correct TGA, UH with outlet chamber to the left). In the diagnosis of the anomalies of the first group, absence of P wave alteration, downward and rightward QRSA, lack of s wave in AVF and terminal forces of the QRS loop under the O point suggest Tetralogy of Fallot. In DORV and TGA the QRSA may be directed upward to the right or to the left and P wave may show overload pattern of the right ventricle. Moreover, in DORV conduction delays on the right bundle branch and/or increased voltage of the R wave in V1 may be observed. In diagnosis between TA and UH with outlet chamber to the right, a leftward displacement of QRSA, an overload pattern of RA and absence of clockwise rotation of the QRS loop on the H plane suggest the former disease. These electrocardiographic data, as well as pathological considerations, made us keep these two form distinct from a clinical point of view. Finally, recording of LV potentials in V1 or to its right with AV conduction abnormalities are typical of corrected TGA; in UH with outlet chamber to the left no conduction defects are observed. In UH with outlet chamber anterior o slightly to the left, ECG pattern is rS on all the praecordial leads and a left posterior hemiblock is present in 40% of the cases of second type.

[Electrocardiographic and vectorcardiographic aspects of tricuspid atresia]. / Quadro elettrovettorcardiografico nell'atresia della tricuspide.

18 patients, less than one year old, with tricuspid atresia have been studied and the electrocardiographic pattern has been correlated to the hemodynamic data and type of ventriculo-arterial connection. The origin of the most frequent electro-vectorcardiographic pattern, such as the variable direction of electrical axis, left ventricular hypertrophy, the right atrial overload, the frequent counterclockwise rotation of the QRS loop on the various planes and the increased voltage of the 0.01" and LMSV spatial vectors are discussed. Moreover, the relevance of anatomic features of the two ventricles and of the position of the conduction pathways in determining the different electrocardiographic pattern in the two types of ventriculo-arterial connection, is underscored. On the basis of our results the opportunity to maintain a distinction between tricuspid atresia and single ventricle, at least from a clinical point of view, seems justified.

Comparative accuracy of cross-sectional echocardiography and cineventriculography for left ventricular evaluation after myocardial infarction.

223 patients with a previous myocardial infarction (MI) 29-68 years old, have been studied in a double-blind manner both by 2D-Echocardiography and cineventriculography. 5 cross-sectional views and 2 angiographic projections have been employed in order to assess the presence of aneurysm and the motion of the left ventricle. The left ventricle has been divided into 5 anatomic regions: interventricular septum, anterolateral, posterolateral, apical and inferior walls. By cineangiography an aneurysm was diagnosed in 89 patients (one pseudoaneurysm); by 2D-Echo in 83 patients an aneurysm was diagnosed, whereas in the 6 remaining patients the Echocardiogram was nondiagnostic (specificity 100%, sensitivity 93%). Concerning regional motion characteristics, 997 (89%) of 1115 regions were visualized and 905 (91%) correctly identified according to the angiographic findings. Of 92 discrepancies (9%): 64 were attributed to 2D-Echo (69%) and 28 (31%) were attributed to cineangiography; most of the discrepancies attributed to echo resulted from minor grades of asynergy which caused unresolved disagreements between the Echo and angiography findings. It is concluded that Cross-sectional echocardiography is a valuable tool for the diagnosis of aneurysm of the left ventricle (specificity 100% and sensitivity 93%) and for the study of wall motion characteristics. In cases with generalized abnormality of left ventricle motion, resulting in a picture of congestive cardiomyopathy, 2D-Echo can be a substitute for cineangiography. In all other instances both techniques can provide more complete information on ventricular wall abnormalities.

[Pulmonary stenosis with intact interventricular septum: qualitative and quantitative analysis of the vectorcardiogram (author's transl)]. / Stenosi polmonare a setto interventricolare integro. Analisi qualitativa e quantitativa dell'esame vettorcardiografico.

Eighty-one patients suffering from pulmonary stenosis with intact interventricular septum were divided into two groups according to their age: Group I (greater than 2 years), Group II (less than 2 years). In Group I, patients with RVSP up to 50 mmHg have been included in subgroup A; patients with RVSP from 50 to 90 mmHg in subgroup B, patients with RVSP greater than 90 mmHg in subgroup C. In Group II forms with RVSP less than or equal to 60 mmHg have been considered moderate and forms with RVSP greater than 60 mmHg severe. The rotation and duration of the QRS loop on the various planes, presence of a terminal slowing, the ratios 0,01"/LMSV and 0,02"/LMSV, the LMSV and the RMSV in order to assess the most significant vcgraphic parameters to predict severity of the stenosis have been analysed. A fair correlation has been found between RMSV and RVSP (r = 0,55 in Group I; r = 0,54 in Group II). The AA. conclude that a counterclockwiseloop on the H plane and the presence of a terminal slowing are the most reliable parameters for recognizing the light forms, while the clockwise loop on the H plane and a markedly increased voltage of RMSV indicate more severe stenosis.

[The contrast echocardiography for the diagnosis of the venous system anomalies. Echo-angiographic correlations (author's transl)]. / L'ecocontrastografia nelle anomalie delle connessioni veno-atriali sistemiche. Correlazione eco-angiografica.

Contrast echocardiography is described as an important technique for the diagnosis of the anomalies of the venous system. Six patients with intrahepatic interruption of the inferior vena cava (IVC), ten patients with persistent left superior vena cava (PLSVC) connecting to coronary sinus (CS), one patient with PLSVC connecting to left atrium (LA) and ten patients, control group, with normal venous connections were studied by two-dimensional echocardiography; the injections of dextrose were made into the left hand, right hand, leg; the locations of the transducer were: subcostal position, parasternal and suprasternal. All patients underwent cardiac catheterization and cineangiography. When the injection was made into a leg vein, in the patients with infrahepatic interruption of the IVC we observed the contrast medium descending from the superior vena cava into the right atrium (RA). In the cases with PLSVC connecting to CS, contrast medium injected into the left hand, the sequential clouding of CS, RA and right ventricle was seen. The pattern of opacification in the case of PLSVC connecting to LA is discussed. In conclusion, contrast echocardiographic study of the connections of the venous system may be useful in planning the way for cardiac catheterization and also for the diagnosis of some anomalies which might be mistaken even at the time of the hemodynamic study.