[Association of pulmonary and portal hypertension]. / Associazione tra ipertensione arteriosa polmonare ed ipertensione portale.

The association between portal venous hypertension and pulmonary arterial hypertension has received scarce attention in the italian medical literature. Nevertheless the association is relatively frequent, it needs a multidisciplinary approach and it is a stimulus for the search of causes of so-called primary pulmonary hypertension. The purpose of the article is to review the frequency of the association, the main pathogenetic hypothesis formulated to explain the appearance of pulmonary hypertension, the clinical and the laboratory findings, the evolution of the association and to present briefly a personal series of cases. The pulmonary arterial hypertension has been found in approximately 2% of patients with portal hypertension due to either hepatic cirrhosis or extraepatic lesions. Microembolism from the portocavat system or a number of vasoactive substances which enter the pulmonary circulation without being inactivated by the liver have been held responsible for the appearance of pulmonary hypertension in predisposed patients. Clinical and laboratory findings do not differ from those a patients with primary pulmonary hypertension. Also the prognosis is similar. In conclusion on accurate examination of the pulmonary circulation by noninvasive methods, in particular by echocardiography, appears to be mandatory in patients with chronic hepatic lesions. When pulmonary arterial hypertension is detected the study of the biochemical factors which at present are known to determine pulmonary hypertension may be warranted. The study may enhance our knowledge of the pathogenesis of the so-called primary pulmonary hypertension.

[Obstruction of the superior vena cava following a corrective intervention for total anomalous pulmonary venous return treated by percutaneous angioplasty]. / Ostruzione della vena cava superiore dopo intervento correttivo per ritorno venoso polmonare anomalo totale trattata con angioplastica percutanea.

We report a case of a patient operated on for total anomalous pulmonary venous drainage at the age of six months. Seven years later an angiographic examination showed a obstruction of superior vena cava at Juxta right atrial. The patient, asymptomatic until the age of fifteen, was then subjected to further hemodynamic and angiocardiographic examination due to the appearance of an incessant and therapy-resistant cough. After the diagnostic procedure was completed, percutaneous balloon angioplasty was performed on the obstruction, which marked the remission of the symptoms.

[Pulmonary valve angioplasty via the jugular vein in a 73-year-old female patient]. / Angioplastica valvolare polmonare per via giugulare interna in una paziente di 73 anni.

Percutaneous balloon valvuloplasty was successfully performed in a 73-year-old woman with severe congestive heart failure due to severe calcific valvular pulmonary stenosis. An approach by right internal jugular vein was used for the procedure.

[Pulmonary atelectasis and massive pleural effusion. Echocardiography]. / Atelettasia polmonare e versamento pleurico massivo. Aspetti ecocardiografici.

Pulmonary atelectasis can be detected by Two Dimensional Echocardiography (2D-E) when massive pleural effusion is present. A triangular mass, base toward the mediastinum and apex moving freely in the pleural cavity, is shown by 2D-E either in an apical modified view in left pleural effusions or in a subcostal modified view in right pleural effusions. The texture of the mass is liver-like. Three cases are reported by way of example. Differential diagnosis with other masses, such as pleural or pericardial metastasis, is discussed.

Diastolic time intervals before and after nadolol in patients with hypertrophic cardiomyopathy.

In 9 patients with hypertrophic cardiomyopathy, diastolic function was evaluated by noninvasive measurements of diastolic time intervals before and after nadolol administration. No significant variation of the intervals was observed after therapy. The method therefore appears scarcely useful in the evaluation of beta-blocker therapy in these patients.

[Correlations between electrocardiographic findings and echocardiographic patterns in 116 patients with hypertrophic cardiomyopathy]. / Correlazione tra reperti elettrocardiografici e quadri ecocardiografici in 116 pazienti con cardiomiopatia ipertrofica.

To evaluate the correlation between electrocardiographic and echocardiographic m-mode (E-TM) and two-dimensional (E-2D) patterns, 116 patients with hypertrophic cardiomyopathy (HCM) were studied by these two methods. Patients were classified into four types, according to Maron et al's E-2D classification of HCM. In addition a subgroup (IIIb) of 15 patients in types III, had typical left ventricular concentric hypertrophy. Twelve per cent of the study patients had a normal ECG, and most often those patients showed types I-II and IIIb. Left ventricular hypertrophy by ECG was most frequent (46%) and was found mostly in type III (P less than 0.02). Abnormal Q waves, suggestive but not diagnostic of HCM, were found in 22 of 116 (18%) patients, and were present in equal proportion in each morphologic type. Isolated ST-T changes were found in the same percentage of patients. Six of 7 patients with giant negative T waves had apical left ventricular hypertrophy, but 4 other patients with apical hypertrophy had no such ECG findings. Mean left atrial dimensions at E-TM, although larger in patients with atrial fibrillation, with statistical significance (P less than 0.001), were not predictive of this arrhythmia. ECG is still useful in the diagnosis of HCM, although there is no abnormal pattern specific for the disease, and even a normal ECG can be found in these patients.