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Two cases of obstructive hypertrophic cardiomyopathy, in which the transthoracic echocardiography was not enough to reach the right diagnosis, are reported. The transesophageal echocardiography revealed to be the most useful technique to reach the exact diagnosis and more information about the mechanism of the left ventricular outflow tract obstruction. Moreover, this technique could be useful to direct to a surgical treatment and to monitorize the mitral valve function and the possible complications during operation.

We describe a case od echocardiographic visualisation of right atrial thrombus in a patient affected by pulmonary embolism. The thrombus had the characteristic aspect of embolus with venous origin. The litic treatment with rTPA, during echocardiographic monitoring, was effective with disappearance of the thrombus and quick improvement of symptoms.

Two cases of embolic infective endocarditis on bicuspid aortic valve are described. The trans-thoracic and trans-esophageal echocardiographic aspect could leave easily suppose the possibility of embolism. The prophylactic surgical treatment, during the active phase, also if the indication is debated, could have probably avoided the serious consequences of embolism.

Since June 1988 we have implanted 36 VDD pacemakers with single lead catheter which has floating differential sensing (Phymos). The patients were affected by 2nd and 3rd degree AV block with normal sinus node function. The reliability of the pacing system was assessed acutely and after 1 and 3 months and then every six months with ECG, Holter 24 hours monitoring, exercise stress test and nifedipine test. Two patients died during the follow-up period and two had atrial fibrillation. In the remaining patients an AV synchronization between 95 and 100% was demonstrated.

Two cases of left ventricular bands, detected by two-dimensional echocardiography, in two young men are described. In both cases anterior negative T waves were present. Therefore, the possible presence of these structures should always be investigated, by two-dimensional echocardiography, when anterior negative T waves are present in normal young people.

Rupture of interventricular septum is an infrequent but serious complication of acute myocardial infarction. We report the cases of two patients admitted to our department for acute myocardial infarction whose clinical course was complicated by rupture of the interventricular septum. They died from cardiogenic shock on the 13th and 6th days. Two dimensional and color coded echocardiography correctly detected the presence and the site of the rupture.

The authors describe three cases of micro-Ebstein diagnosed using 2D-echocardiography in patients affected by extrasystolic cardiopalm. The most important echocardiographic criterion for diagnosis was an apical displacement of the septal cusp of the tricuspid valve of at least 8 mm/m2 BA. It is generally reported that the severity of arrhythmias is independent of the degree of tricuspid malformation. The anatomical substrates of arrhythmias are persistent anomalous muscular by-passes between the atrium and the ventricles, and intrinsic anomaly of the right ventricular myocardium. For these reasons, it is necessary to follow-up patients and monitor arrhythmias using Holter-ECG. Echocardiography is now recognised as being the most important tool for the identification of this anomaly.

A case of isolated cardiac echinococcosis is reported. A 19-year-old man was hospitalized for chest pain with electrocardiographic pathological Q waves in D1, aVL, V5, V6. Two-dimensional echocardiography and chest computed tomography documented pericardial effusion and an intramyocardial cyst. Casoni's reaction and immunological tests completed the diagnosis of cardiac hydatidosis. The localization and the etiology of the cyst were confirmed during cardiac surgery.