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We describe a clinical case presenting 2 rare features. The first was a spontaneous aortocaval fistula which had developed from rupture of an atherosclerotic aortic aneurysm into the inferior vena cava. The second infrequent feature depended on the unusual method by which the diagnosis was performed. In fact, using an echo-color Doppler flow imaging (HP 77020A ultrasound system) with a 2.5 MHz echocardiographic probe abdominal examination showed an aneurysm of the descending aorta that communicated to a dilated inferior vena cava. Furthermore, flow study with color Doppler showed a continuous turbulent, mixed (arterial and venous) blood flow into the inferior vena cava.

We prospectively followed a cohort of 64 patients bearing an aortic or mitral prosthetic valve (mean follow-up 5.2 +/- 3.2 months) in order to evaluate if color-coded two-dimensional Doppler echocardiography (CFD) could provide some major advantages with respect to pulsed (PW) and continuous wave (CW) Doppler in the diagnostic accuracy of detection of intra-, and paraprosthetic leaks. During follow-up 4 cases of pathologic prosthetic regurgitation ensued and were all correctly and easily identified by CFD while one of them was missed both by PW and CW Doppler. Based on our results we conclude that CFD is the best noninvasive tool actually available for the correct identification of prosthetic valvular regurgitation because it can provide useful accessory information difficult to obtain with other echocardiographic techniques.

The availability of i.v. nicardipine has urged us to prove this drug in the treatment of hypertensive attacks (SAP greater than or equal to 210 mmHg and/or DAP greater than or equal to 110 mmHg). Two groups of patients (each made up of ten subjects) were treated with 2 mg and 5 mg respectively of i.v. nicardipine injected for 4 min while mean systolic and diastolic arterial pressure and heart rate were registered until three hours. I.V. nicardipine administration induced in both groups of patients a decrease in systolic pressure from 20 to 30% while diastolic arterial pressure decreased from 15 to 18% in the first group and from 20 to 25% in the second one. Heart rate showed an initial mild increase following arterial vasodilator action of nicardipine whereas it decreased significantly from 120 min in the presence of an unchanged hypotensive effect of the drug. One patient did not respond to nicardipine while another felt chest pain and palpitations. In conclusion our results are satisfactory and argue for the inclusion of nicardipine among the drugs that may be considered useful for the treatment of hypertensive attacks.

The obstruction of the left ventricular tract outflow following mitral valve surgery, as a late complication, is rarely reported in the literature. The case of a 47-yr-old woman, who, after mitral valve surgery, developed dynamic left ventricular tract outflow obstruction four years later is reported. This alteration was detected by 2D echo-Doppler. The echocardiographic findings were: 1) Normal function of the mitral prosthesis. 2) An equal pressure-gradient of 44 mmHg at rest and of 75 mmHg after amyl nitrite at three examined levels: below, above and at the level of the aortic valve. 3) A hyper-echo image in the peri-annular region, probably representing fibrous degeneration around the valve ring, which was the likely cause of the obstruction. Th data were confirmed by cardiac catheterization. The echocardiographic technique appears to be a useful tool to detect and study this complication of mitral valve surgery.