Normal echocardiographic characteristics of the Sorin Bicarbon bileaflet prosthetic heart valve in the mitral and aortic positions.

Doppler echocardiographic characteristics of normally functioning Sorin Bicarbon prostheses were prospectively assessed in 226 consecutive patients (135 male and 91 female patients, mean age 61 +/- 10 years) with 233 valves in the mitral (n = 67) and aortic (n = 166) positions whose function was considered normal by clinical and echocardiographic evaluation. Patterns of "normal" transprosthetic leakage were assessed with transthoracic echocardiography in all valves and with transesophageal echocardiography in six selected mitral valve prostheses. For the mitral valve prostheses, we found that peak and mean gradient, as well as pressure half-time, were not significantly different in either the 25 or the 31 mm valves (median values from 15 to 10 mm Hg, from 4 to 4 mm Hg, and from 70 to 83 ms; p = Not significant for all). On transthoracic study, 12 patients (17%) with a Sorin Bicarbon valve in the mitral position showed minimal transprosthetic leakage. On transesophageal study, all patients showed a transprosthetic leakage whose spatial distribution had a complex pattern: in planes orthogonal to the leaflet axis, two to four jets arising from the hinge points and converging toward the center of the valve plane could be visualized; in planes parallel to the leaflet axis, there were three jets, the two lateral ones diverging and the central one perpendicular to the valve plane. For the aortic valve prostheses, there was a significant decrease in transprosthetic gradients and an increase in effective orifice areas as prosthesis size increased. Peak and mean gradients decreased from a median value of 25 and 13 mm Hg in the 19 mm valves to 9 and 5 mm Hg in the 29 mm valves, respectively. Effective prosthetic valve area calculated with the continuity equation increased from a median value of 0.97 cm2 for the 19 mm size valves to 3.45 cm2 for the 29 mm size. With analysis of variance, effective prosthetic aortic valve area differentiated various valve sizes (F = 40.9, p < 0.0001) better than peak (F = 10.3, p < 0.0001) or mean (F = 8.04, p < 0.0001) gradients alone did. Furthermore, effective prosthetic aortic valve area correlated better than peak and mean gradients with prosthetic size (r = 0.76, r = -0.45, and r = -0.39, respectively). On transthoracic study, 109 patients (66%) showed minimal transprosthetic leakage. These normal values, obtained in a large number of patients with normofunctioning mitral and aortic Sorin Bicarbon valves, may help to identify Sorin Bicarbon prosthesis dysfunction.

[Aneurysm of the interatrial septum. Description of a case]. / Aneurisma del setto interatriale. Descrizione di un caso.

Echocardiography (M-mode and 2-dimensional) has identified unusual cardiac anomalies which, not related with cardiac murmurs or clicks or other clinical marks, had not been elsewhere discovered. Among them there is the atrial septal aneurysm, which often occurs with other cardiac malformations (congenital or acquired), but sometimes occurs as an isolated abnormality. The Authors report a case of isolated atrial septal aneurysm, detected in a 6 year-old boy.

Total body potassium and long-term treatment with amiloride HCL and/or hydrochlorothiazide.

The potassium sparing effect of 5 mg of amiloride (A) given either alone, or in combination with 50 mg of hydrochlorothiazide (HCTH) was evaluated in 23 patients with essential hypertension on a daily diet containing 70 mEq of K and 130 mEq of Na. Two studies were carried out. In the first, patients received HCTH alone (2 months) followed by A alone (2 months) and the two combined (6 months). The results of this study demonstrate that A is capable of correcting and preventing the loss of serum and total body potassium (TBK) and of reducing the increase of serum uric acid induced by HCTH. In the second study, each patient received from the beginning A + HCTH for 12 months; no statistically significant changes for serum and total body potassium and for serum uric acid appeared in any patient after six and twelve months. This study proves that A is capable of clinical potassium sparing effect in hypertensives and that this effect is a long lasting one.