[Sequential approach to the diagnosis of ischemic cardiopathy]. / Approccio sequenziale alla diagnosi della cardiopatia ischemica.

The detection and the assessment of ischaemic heart disease require the utilization of several diagnostic techniques and skills; non-invasive tools, like echo-doppler cardiography and nuclear cardiology, are gaining more and more importance. This paper describes a sequential approach to the diagnosis of several manifestations of ischaemic heart disease--angina, unstable angina, post-infarction angina, pump failure, arrhythmias--, purposing a sequence of tests for each manifestation, starting from the simplest techniques to end with more complex investigations. Indications to coronary angiography and to medical or surgical therapy are also discussed.

[Aneurysm of ascending aorta associated with aortic valve incompetence. Surgical correction by replacement of right coronary artery in 15 patients (author's transl)]. / L'aneurisma dell'aorta ascendente associata ad insufficienza valvolare. Correzione chirurgica radicale con reimpianto delle coronarie in 15 pazienti.

15 patients with aneurysm of ascending aorta associated with aortic valve incompetence has been treated by the replacement of the aortic valve and ascending aorta with reimplantation of the right coronary artery in 8 patients and both coronary arteries in 7. The operative mortality was 13% (2 patients). The follow up interval ranged from 6 months to three years (mean 20 months) and in all 13 patients there was an improving of functional class. A post-operative angiography was performed in 6 patients and in all of them was demonstrated the patency of the neoostia, a minimum paravalvular leak in one patient, and a pseudoaneurysm in another one. Proving the necessity of complete replacement of aneurysmal aorta, the Authors discuss the technique adopted with particular reference to the problem of reimplantation of the coronary arteries.

[Uncommon evolution of aneurysm of the ascending aorta in Marfan syndrome. A case report (author's transl)]. / Evoluzione insolita di aneurisma dell'aorta ascendente nella sindrome di Marfan. A proposito di un caso.

The Authors report a case of aneurysm of the ascending aorta in Marfan syndrome, with fatal outcome (2 months after the onset of the symptoms), caused neither by dissection nor by rupture of the aorta, but by serious myocardial involvement due to anoxic damage and acute volume overload of left ventricle. The Authors describe the possible mechanisms of this evolution and point out the usefulness of the identification of this uncommon evolution for a useful and opportune surgical therapy.

[Echocardiographic aspects of prosthetic porcine valves. Observations on 125 personal cases (author's transl)]. / Aspetti ecocardiografici delle protesi valvolari porcine. Osservazioni in 125 casi personali.

Echocardiograms were performed on 111 prosthetic porcine valves in mitral position and 25 in aortic position. Satisfactory tracings were obtained in 68% of the mitral and in 80% of the aortic prosthesis. The characteristic appearance of the porcine prosthesis consists of two lines parallel to each other which represent the stent; the valve cusps reflect much thinner echoes with a box-like pattern similar to that of the normal aortic valve. The distance between the cusps varied from 12 to 17 for the mitral prosthesis and from 11 to 15 for the aortic prosthesis. The range of these values as well as the range of other parameters which were measured varies widely. We suggest therefore that a post-operative echocardiogram should be performed to get a baseline pattern useful for comparison with following controls.

[Mitral insufficiency associated with interatrial defect (ostium secundum). Problems of diagnosis and surgical treatment]. / L'insufficienza mitralica associata a difetto interatriale (ostium secundum). Problemi di diagnosi e di terpaia chirurgica.

Of the 255 patients under observation of the AA. with ostium secundum interatrial defect who underwent surgery, 23 (9%) presented an associated mitral regurgitation. All patients had a hemodynamic test and a complete contrahistography, 8 patients polygraphic and 5 patients echocardiographic examinations. The clinical data alone, ecgraphic and Rx, supplied sufficient indications for a correct diagnosis in 87% of the cases. 22 patients underwent surgery: the septal defect was corrected in all patients, mitral regurgitation only in 9; in 5 by valve substitution, in 4 through conservative techniques. Only one patient died of cerebral coma. A report is made on the data relative to the clinical history, Rx, ecgraphic and hemodynamic examinations of the 23 patients under observation, the various anatomosurgical aspects of the valvular alterations, and the criteria adopted for the surgical correction of the mitral regurgitation.

[Bypass of the outlet of the left ventricle with a Hancock valve tube: report of two cases surgically treated (author's transl)]. / Il bypass della via di efflusso del ventricolo sinistro con tubo valvolato di Hancock. A proposito di due casi operati.

The Authors describe two cases in which the outlet of the left ventricle was recreated by means of a bypass with a valve tube. The first is a case of correct levo-transposition of the great vessels with atresia of the pulmonary, in which a valve tube was applied between the inverted left ventricle and the right branch and trunk of the pulmonary. The second is a case of "long" fibrous subvalvular aortic stenosis, a relapse from former correction of membranous subaortic stenosis, in which bypass was applied between the left ventricle and the ascending aorta. This latter method, adopted by McGoon, is held by the Authors to be easier to apply and more physiological in its hemodynamic effects. The clinical and instrumental results were good in both cases. The hemodynamic and cardioangiographic controls carried out in the second case, 4 months after the surgical operation, showed the normal functioning of the prosthesis, an outflow equal to 60.3% of the total capacity through the bypass, and the ample neostomy of the left ventricle in systolic phase.

[Open heart mitral commissurotomy: experience with 286 cases (author's transl)]. / Commissurotomia mitralica a cuore aperto Esperienza su 286 casi

A total of 286 patients with mitral stenosis or predominant mitral stenosis underwent open heart mitral commissurotomy at the San Camillo Hospital between May 1969 and May 1975; mitral annuloplasty was performed on 71 patients, subvalvular apparatus correction on 43. The operative mortality rate was 0,7% (no deaths among the last 220 patients). Early results, evaluated from intraoperative data, clinical course, acoustic and polygraphic postoperative findings, were good in 228 patients (80%), fairly good in 41 (14%), bad in 17 (6%).