The role of intraoperative transoesophageal echocardiography in the diagnosis and management of a rare multiple fibroelastoma of aortic valve: a case report and review of literature.

Papillary fibroelastoma is the third most common primary tumour of the heart that usually involves the cardiac valves. Multiple papillary fibroelastomas are extremely rare. We report a case with multiple valve papillary fibroelastoma which was identified only by intraoperative transoesophageal echocardiography. The patient complained of atypical chest pains. She was affected by coronary artery disease and had previously had a myocardial infarct. This finding dictated a change in the operative approach. The aortic valve resection was performed in addition to coronary revascularization. If the intraoperative transoesophageal echocardiography was not performed, our patient would have had just coronary artery bypass graft surgery, probably without solving the symptoms. Furthermore, in future she would have undergone another cardiac operation for resection of aortic masses and valve replacement. The intraoperative use of Transoesophageal Echocardiography improves the diagnosis and the management of all cardiac surgical patients.

[Three good reasons to perform a postmortem examination in all cases of juvenile sudden death]. / Tre buoni motivi per richiedere sempre un'autopsia nei casi di morte improvvisa giovanile.

The aim of this review is to underline the reasons why a post-mortem examination has to be performed in all cases of juvenile sudden death. Sudden death in children and young adults can be caused by potentially heritable cardiovascular disorders and fatal outcome is often the first symptom in apparently healthy subjects. In these cases, a careful autopsy, performed according to a standardized protocol, becomes the sole diagnostic tool to guide clinical and molecular genetic family screening and to adopt the proper therapeutic and preventive strategies. Thus, a post-mortem examination is a fundamental part of a multidisciplinary approach to the issue of juvenile sudden death.