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This paper deals with a literature survey on natriuretic peptides (NP) and their clinical use in prognostic stratification and therapy of arterial hypertension and cardiac failure. After a brief historical introduction, the phylogenesis of NP is analyzed and the reasons of their preservation in the evolution are emphasized. The biochemistry of the NP is then treated, and the structure, synthesis, mechanism of cellular action and systems of regulation are analyzed. Subsequently, the authors have analyzed the physiology of the NP as well as their hemodynamic and biohumoral effects and actions on the central nervous system. A literature review on the significance of NP in arterial hypertension, on their usefulness as indicators of damage and on their therapeutic practice is then made. In particular, the possible future applications in the prevention of atherosclerotic damage are analyzed. The significance of NP and of their metabolites in heart failure and the prognostic implication of these peptides particularly in ischemic heart failure are then discussed. The most important papers on this topic are described. Finally the studies on the use of NP in the therapy of heart failure are analyzed and a guide on research of this topic is defined.

Background: The MS200 Cardioscope, from MRT Micro as., Norway, is a 12 channel ECG card to be directly inserted into a standard personal computer (PC). The standard ISA Bus compatible half length card comes with a set of 10 cables with electrodes and the software for recording, displaying and saving ECG signals. The system is supplied with DOS or Windows software. The goal of the present work was to evaluate the affordability and usability of the MS200 in a clinical setting., Materials and Methods: We tested the 1.5 DOS version of the software. In 30 patients with various cardiac diseases the ECG signal has been recorded with MS200 and with standard Hellige CardioSmart equipment. The saved ECGs were recalled and printed using an Epson Stylus 800 ink-jet printer. Two cardiologists reviewed the recordings for a looking at output quality, amplitude and speed precision, artifacts, etc., Results: 1) Installation: the card has proven to be totally compatible with the hardware; no changes in default settings had to be made. 2) Usage: the screens are clear; the commands and menus are intuitive and easy to use. Due to the boot-strap and software loading procedures and, most important, off-line printing, the time needed to obtain a complete ECG printout has been longer than that of the reference machine. 3) Archiving and retrieval of ECG: the ECG curves can be saved in original or compressed form: selecting the latter, the noise and non-ECG information is filtered away and the space consumption on disk is reduced: on average, 20 Kb are needed for 10 seconds of signal. The MS200 can be run on a Local Area Network and is prepared for integrating with an existing informative system: we are currently testing the system in this scenery. 4) MS200 includes options for on-line diagnosis, a technology we have not tested in the present work. 5) The only setting allowed for printing full pages is letter size (A4): the quality of printouts is good, with a resolution of 180 DPI., Conclusions: In conclusion, the MS200 system seems reliable and safe. In the configuration we tested, it cannot substitute a dedicated ECG equipment: from this point of view, a smaller PCMCIA-type card with a battery-operated notebook PC will be more suitable for clinical uses. Nevertheless, the possibility to log and track ECG records, integrated into the department informative system, may provide a valuable tool for improving access to medical information.

We present a case of left ventricular pseudoaneurysm diagnosed by chance 6 years after a second surgical intervention on the mitral valve (replacement with a St. Jude prosthesis). A combination of cross sectional and color-Doppler studies led to the correct diagnosis. A transesophageal echocardiographic investigation did not provide further information, while the diagnosis was confirmed by computed tomography with contrast agent. A retrospective analysis of previous examinations revealed that the pseudoaneurysm developed shortly after the mitral valve replacement, remaining stable over the years. The patient was clinically asymptomatic, the size of the pseudoaneurysm did not increase during a 2 years followup, and we decided to follow a conservative treatment.

Cor triatriatum (CT) is a rare malformation consisting of a fibromuscolar membrane that subdivides the left atrium in a postero-superior (or accessory) chamber and an antero-inferior chamber (true left atrium, containing the left atrial appendage). In its classic form, the accessory chamber receives the pulmonary veins and communication with the left atrium is accomplished by way of one or more fenestrations in the membrane. The malformation is usually isolated, but in about one in four patients is associated with other congenital defects of a complex nature. We describe a case of CT associated with atrial septal defect, in which transthoracic echocardiography failed to document the existence of CT membrane, while this abnormality was clearly seen and defined by use of transesophageal echocardiography. The patient was a 26 year-old girl, presented at our outpatient clinic after an episode of palpitations and dyspnea, which lasted for two hours. She suffered of mild dyspnea on exertion during the last three months. Physical examination revealed the typical findings of an atrial septal defect (ASD), and the electrocardiogram revealed right bundle branch block. The two-dimensional echocardiography disclosed an ostium secundum ASD with left to right shunt; dilatation of the right cavities; paradoxical movement of the interventricular septum. A small linear echo originating from the lateral wall of the left atrium, with no evidence of turbulent flow on pulsed wave Doppler and color flow examination, was interpreted as an artifact. Transesophageal echocardiography clearly visualized a tense, bulging membrane separating left atrium into two chambers.(ABSTRACT TRUNCATED AT 250 WORDS)