Traumatic tricuspid insufficiency: a case report with a review of the literature.

Traumatic tricuspid insufficiency, a rare complication of blunt chest trauma, has been reported with increasing frequency during the last 40 years. Automobile accidents are the leading cause of traumatic tricuspid valve regurgitation. The most frequently reported injury is chordal rupture, followed by rupture of the anterior papillary muscle and leaflet tear, primarily of the anterior leaflet. In the acute phase of the injury, the traumatic lesion may go undetected. In the chronic phase many patients remain asymptomatic and others exhibit symptoms and signs of moderate to severe right heart failure. Clinically overt right heart failure has been the traditional indication for surgery, which usually consisted of tricuspid valve replacement. More recently, a more aggressive strategy, with surgical repair of the valve performed before deterioration of the right ventricular function occurs, has been advocated.

Ruptured aneurysm of the sinus of Valsalva associated with an atrial septal aneurysm.

Aneurysm of the sinus of Valsalva (ASV) is a rare cardiac disease that may be acquired or congenital. It is usually an asymptomatic condition; however, when it ruptures, symptoms appear and the condition deteriorates rapidly. Atrial septal aneurysm (ASA) is a localized "saccular" deformity of the interatrial septum that is associated with cerebrovascular events of embolic origin. We will report on a case of a 69-year-old woman who was referred to our department because of congestive heart failure. Echocardiographic evaluation, both transthoracic and transesophageal, disclosed a ruptured aneurysm of the right sinus of Valsalva into the right atrium (RA), which was associated with an aneurysm of the atrial septum.

Effect of different AV delays on left ventricular diastolic function and ANF levels in DDD paced hypertensive patients during daily activity and exercise.

Fifteen hypertensive patients (13 men) with left ventricular hypertrophy, mean age 69 6 5 years, having complete heart block and paced in the DDD mode, were studied by two-dimensional and Doppler echo in 100 and 200 ms atrioventricular delays. ANF plasma levels were measured at rest and at peak exercise, during pacing with the two different atrioventricular delays. ANF plasma levels were significantly higher at pacing with long atrioventricular delays (200 ms), at rest (152.47 6 12.38 pg/mL vs 119 6 12.38 pg/mL, P, 0.001) and at exercise (180.93 6 11.51 vs 123.67 6 16.24 pg/mL, P, 0.0001). ANF plasma levels were significantly increased at exercise, compared to those at rest during pacing with the two different atrioventricular delays, but we found a more pronounced increase of ANF levels (from 152.47 6 10.49 pg/mL to 180.93 6 11.51 pg/mL), when the atrioventricular delays was set to 200 ms (P, 0.0001). A significant decrease of isovolumic relaxation time (from 123.33 6 20.5 to 105.33 6 11.06 ms, P, 0.001) was observed, during pacing with the short atrioventricular delays. Moreover, the peak early (E) to peak atrial (A) velocity ratio (E/A) was declined (from 0.89 6 0.7 to 0.57 6 0.18, P, 0.05). We also noticed that patients with small left ventricles exhibit greater increase in ANF plasma levels during DDD pacing with long atrioventricular delays (r 5 20.792, P 5 0.000). In conclusion, left ventricular diastolic function of our patients seems to be improved during DDD pacing with short (100 ms) atrioventricular delays, as it was expressed by echocardiographic and hormonal measurements.

Thirty one-year durability of a Starr-Edwards aortic prosthesis.

We report the case of a 57-year old man who was admitted to our department because of worsening dyspnea - orthopnea and whose aortic valve had been replaced 31 years previously, with a Starr-Edwards caged-ball prosthesis. His symptoms' deterioration was due to a recent myocardial infarction which in combination with the chronic mitral regurgitation of rheumatic origin led to heart failure. As assessed by echocardiography the mechanical prosthesis did not show signs of significant dysfunction and except for mild regurgitation, it had a good performance. Despite some valve related complications, such as the recurrent thromboembolic events that our patient had, his Starr Edwards aortic prosthesis demonstrated an excellent long term durability and reliability.

Evaluation of left ventricular diastolic function in patients with non-Q-wave myocardial infarction and its correlation with underlying coronary artery disease.

Left ventricular diastolic function was studied by Doppler echocardiography in 35 patients with non-Q-wave myocardial infarction, on the third and tenth day of hospitalization and six weeks after hospitalization and was correlated with electrocardiogram, serum enzyme values, and angiographic data. Normal diastolic function on the first echocardiographic study predicted (p = 0.0001) the existence of no or single-vessel disease, and excluded (p = 0.005) the presence of 3-vessel or left main disease, whereas an abnormal study on either the second or third echocardiographic discriminated (p = 0.0001), with higher sensitivity (80.97%, 92.31%, respectively), patients with 3-vessel or left main vessel disease.

Lateral cephalometric radiographs: an aid in detecting patients at risk of stroke.

Stroke is often caused by atherosclerotic lesions in the bifurcation of the common carotid artery. The authors evaluated conventional lateral cephalometric radiographs of 1,063 healthy men aged 25 to 85 years for the presence of such lesions. Approximately 2 percent of these people had lesions, which were at the level fo the third and fourth cervical vertebrae and were superimposed over these structures, the pre-vertebral fascia and the pharyngeal air space. People with atherosclerotic lesions should be referred to their physicians because timely medical, surgical and lifestyle interventions can prevent strokes.

A comparison of impression materials for complete-arch fixed partial dentures.

This study compared the marginal fit of complete-arch fixed prostheses under simulated clinical conditions. Prostheses were made on casts constructed from three commonly used impression materials; polyether, polyvinyl siloxane (medium-viscosity and putty-wash), and reversible hydrocolloid. A maxillary dentoform with four abutment teeth was used as the master cast and six impressions were made with each material. Individual castings for each abutment were made on the stone casts. The abutment castings were luted together on the casts to provide a complete-arch fixed partial denture using a ticonium framework and acrylic resin. The marginal fit of the abutment castings was measured on the master cast before and after the prostheses were luted together. The polyether and both addition silicone impression materials were significantly more accurate than the reversible hydrocolloid in both situations. All of the single castings were clinically acceptable, but the luted restorations made from reversible hydrocolloids were not.