[Aortic dissection: an incidence study based on hospital cases]. / Dissecazione aortica: studio dell'incidenza basato su una casistica ospedaliera.

To ascertain the incidence of aortic dissection, we retrospectively studied the data base of our hospital (Ospedale di Treviso-ULSS n 10). The population in the Treviso area is well defined as a geographic settlement and was sufficiently stable from a demographic point of view in the period examined (1976-1988). Patients were selected on the basis of established aortic dissection diagnosed by angiography, surgical inspection or autopsy. One hundred eighty-seven patients were included: 126 of them lived in the hospital-referring area (mean annual population of 239824 people in the study period). The calculated incidence of aortic dissection was 40.4 new cases/million inhabitants/year. This figure is consistently higher than that reported in the literature. The outcome of the study is discussed and data are compared with those of previously published papers.

Left-atrium-to-right-ventricle shunting after surgery for atrioventricular septal defect: an unusual sequel detected by transesophageal echocardiography.

A 25-yr-old female who had undergone surgery for common atrium and atrioventricular septal defect at the age of 9, was found to have residual shunting at the level of the atrioventricular junction. Precordial echocardiography failed to assess the direction of the shunt. Transesophageal echocardiography showed dehiscence of the atrial patch at the level of the atrioventricular junction. Through this defect left-atrium-to right ventricle shunting occurred in diastole, whereas in systole the defect was closed by the juxtaposition of the anterior tricuspid valve leaflet.

Transesophageal echocardiographic findings in partial and complete papillary muscle rupture complicating acute myocardial infarction.

Papillary muscle rupture occurred in two patients with recent inferior myocardial infarction. In one case with partial rupture transesophageal echocardiography in the standard four-chamber view did not visualize the rupture and in the second case with complete rupture it provided incomplete diagnostic information. A not previously described transgastric longitudinal scanning of the left ventricle provided complete delineation of the lesion and it was of great value in the diagnosis and management of this potentially lethal complication. Both patients were operated upon and had a favourable outcome.

Coronary angioplasty in single-vessel complex lesions: short- and long-term outcome and factors predicting acute coronary occlusion.

Percutaneous transluminal coronary angioplasty (PTCA) of complex coronary lesions (plaque ulceration and/or thrombus) has an increased risk of procedural complications. To assess the influence of these angiographic features on immediate and long-term results of PTCA, we prospectively compared the success rate, incidence of procedural complications, and restenosis rate in two groups of patients selected on the basis of the presence (study group = 30 patients) or absence (control group = 200 patients) of complex morphology at the time of angioplasty. The two groups were similar with regard to extent of coronary artery disease and site of coronary stenosis. Patients in the study group had a higher incidence of periprocedural acute coronary occlusion (47% vs 6%; p less than 0.01), which in 78% of the cases was successfully treated with repeat angioplasty and intracoronary thrombolysis. Univariate correlates of this complication were Canadian Cardiovascular Society class IV (57% vs 19%; p less than 0.05) and recent (less than 30 days) onset of worsening of symptoms (71% vs 31%; p less than 0.05). The incidence of acute myocardial infarction was slightly higher in the study group (6.7% vs 2%; p = NS), and the success rate with redilatation was the same (90%). Clinical and angiographic follow-up data were obtained from all patients in whom the procedure was successful; the restenosis rate was 55% in the study group compared with 36% in the control group (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Type A aortic dissection: the role of angiography in identifying morphologic features in comparison with autopsy and surgical findings]. / Dissecazione aortica di tipo A: ruolo della angiografia nella valutazione delle caratteristiche morfologiche; confronto con i reperti anatomici e chirurgici.

To evaluate the reliability of cineangiography in identifying some morphologic characteristics of type A aortic dissection, the angiograms of 36 consecutive patients were retrospectively revised and compared with the surgical of necropsy findings. The following features were examined: site and extension of intimal tear (s); extension of the wall dissection; coronary and brachiocephalic arteries involvement; coexisting anuloaortic ectasia; aortic valve state. The angiographic diagnosis of site and extension of the intimal tear was correct in 97 (35/36) and 100% of cases respectively. In one case the presence of an intimal tear at the level of the aortic arch was missed because of the superimposition of the innominate artery. The extension of the wall dissection was correctly identified in 24 out of 25 patients. In one case the presence of distal false lumen thrombosis made the correct diagnosis impossible. The brachiocephalic arteries involvement was always correctly stated while the coronary involvement was suspected in 6 and confirmed in 5 (1 false positive). Anuloectasia was suspected in 12 and confirmed in 10 (2 false positives). In our experience the most challenging diagnosed were the presence of aortic arch tears and the aortic arch and coronary arteries involvement in the dissection. This study confirms that many morphologic features of type A aortic dissection can be adequately assessed by cineangiography.

[The Italian experience in permanent pacing. A casuistry for more of 10 years: a policentric study (author's transl)]. / L'esperienza italiana con l'elettrostimolazione permanente a lungo termine. Casistica in trattamento da oltre 10 anni: studio policentrico.

According to a recent national survey, 387 patients were treated by permanent pacing in 10 Italian centers, between 1961 and 1966. Of these patients 205 have died; 131 (77 males and 54 females) are still alive and no informations could be obtained for the remaining 51 (13%). The overall survival of patients treated during this period of time is therefore not less than 34% which is comparable to that of general population of the same age group. The 131 patients still alive have totaled 1,486 years of pacing and have used up to 784 pacers. Comparing the incidence of the most common causes for replacement during the periods 1961-66 and 1973-77, electrode failures dropped from 21 to 0.9%; circuitry malfunctions occurred in 10.5 and 7.8%; battery depletion rose from 36.8 to 69% of the cases. According to their clinical conditions, the 131 patients on long-term follow-up can be grouped as follows: 62% are in class 1 or 2 of NYHA; 26.7% are in class 3, and 3.8% in class 4. Moreover, 53.4% of patients are living an active life, having some sort of occupation and 29% are holding a driving license.