[Papillary fibroelastoma of the septal leaflet of the tricuspid valve. Report of a case and review of the literature]. / Fibroelastoma papillare del lembo settale della valvola tricuspide. Descrizione di un caso e revisione della letteratura.

Papillary fibroelastoma is a rare benign cardiac tumor typically attached to the cardiac valves. The tumor is recognized during life, more often in patients evaluated for embolic events of unclear pathology, but sometimes also in totally asymptomatic patients. There is a general agreement that left-sided fibroelastomas must be removed to avoid systemic complications. Right-sided localization is even rarer. We report a case of a young woman with a papillary fibroelastoma arising from the septal leaflet of the tricuspid valve. It was detected by two-dimensional transthoracic echocardiography and confirmed by transesophageal echocardiography. To our knowledge, this is the seventeenth reported case of a tricuspid valve papillary fibroelastoma, found by means of echocardiography. The tumor was successfully treated by complete surgical excision, without damage of the tricuspid valve. The best therapeutic strategy to be applied in asymptomatic cases is discussed.

[Carcinoid heart disease and primary ovarian tumor]. / Cuore carcinoide e tumore primitivo dell'ovaio.

Carcinoid heart disease occurs in about one third of patients with carcinoid syndrome, especially in those with ileal carcinoid and hepatic metastases. Patients with primary ovarian carcinoid tumor are extremely rare. In these circumstances, typical carcinoid cardiac lesions may develop unassociated with hepatic metastases, due to the venous drainage from the ovaries into the inferior vena cava of vasoactive released substances such as serotonin. The present report describes a woman with unrecognized primary ovarian carcinoid tumor, unexpectedly exhibiting heart failure. Diagnosis was performed on the basis of echocardiographic findings, occurrence of diarrhea and increased levels of 5-hydroxy-indoleacetic acid (5-HIAA). After complete surgical removal of the tumor, the patient was maintained under therapy with ACE-inhibitors and diuretics. Levels of 5-HIAA are still within normal range, there is regression of heart failure and echocardiographic findings are stabilized. These data confirm the importance of prompt diagnosis for a favorable prognosis of carcinoid heart disease.

Large infero-posterior wall pseudoaneurysm of the left ventricle: an unusual presentation.

Post-myocardial infarction left ventricular pseudoaneurysm resulting from free wall rupture is a rare finding and its recognition during life is uncommon. The diagnosis is difficult since symptoms, clinical evaluation and electrocardiographic and X-ray findings are usually non-specific. We herein present a case of a pseudoaneurysm manifesting after a silent myocardial infarction and diagnosed at echocardiography in a patient who, at the time of hospitalization, had a history and clinical and laboratory findings suggestive of pulmonary embolism. The patient was successfully operated. The present report underlines the diagnostic and prognostic value of two-dimensional transthoracic echocardiography. The clinical and laboratory findings are also discussed in the light of the recent literature.