[Short- and medium-term treatment of ventricular hyperkinetic arrhythmia with flecainide]. / Trattamento a breve e medio termine delle aritmie ipercinetiche ventricolari con flecainide.

Our study group included 12 patients (4 males, 8 females), mean age 60 yr, with symptomatic or threatening tachyarrhythmias (Lown classes IV A, B, V); 2 patients were suffering from mitral valve prolapse syndrome, 2 from ischemic heart disease; 4 from cardiac insufficiency caused by hypertensive or ischemic heart disease; 4 had no evident clinical signs of cardiopathy. Patients suffering from: cardiac insufficiency (F.C. III e IV NYHA); II and III degree BAV; atrial flutter and fibrillation; long QT syndrome; acute ischemic heart disease were excluded from the study. During short-term treatment, patients received placebo for four days and subsequently flecainide 200 mg daily for four days. During medium-term treatment patients received flecainide 200 mg daily (for six months). Several Holter/24-hour monitorings were performed for evaluation of therapy. No significant reduction in the number of ectopic ventricular beats (B.E.V.) was found with placebo whereas reductions of B.E.V. number (97% and 95%, respectively) were found during short and medium-term treatment with flecainide. Flecainide produced: changes in Lown class: from IV A, B and V to II and I; a marked reduction of subjective symptoms (dyspnea, giddiness syncope, precordial pain); ECG changes: increases in: PR: 5-25%; QRS: 11-12%; QT: 11-22%. Flecainide produced no pro-arrhythmic effects or changes in echocardiographic ventricular function index. Flecainide can be considered one of the most effective new antiarrhythmic drugs.

[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.