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The acquired aneurysm of the left aortic sinus is a rare lesion. We observed two cases: the former ruptured in the left ventricle, the latter in the right ventricle. Both cases were identified by echocardiographic examination. The diagnosis was confirmed by the cardiac catheterization and aortography and then at cardiac surgery. In the latter case the diagnosis of rupture was done using Doppler technique. Our experience indicates that, at least in selected cases, the diagnosis of aneurysm of Valsalva sinus and that of rupture are possible by means of two-dimensional and Doppler echocardiography.

The aim of Mobile Coronary Care Units (M.C.C.U.) is to reduce the delay in delivering intensive care to patients with a heart attack. In the city of Florence a M.C.C.U. has been available since November 1979. During the first year the staff of the M.C.C.U. has treated 158 cases of serious cardiac arrhythmias which occurred among 486 interventions. In 94 patients cardiac arrhythmias followed an acute coronary attack. In 64 patients coronary heart disease could not be demonstrated. This study concerns the latter group of patients. The mean age was 65.2 years and 39 patients (61%) were women. The mean time from the onset of the symptoms to the arrival of the M.C.C.U. team was 3h and 2 min, whereas the mean time from the call to the arrival was 14 min. Sixty patients had atrial arrhythmias (29 atrial fibrillation, 2 atrial flutter, 22 atrial tachycardia, 7 premature atrial contractions) and 4 patients had ventricular arrhythmias (1 ventricular tachycardia, 1 ventricular flutter, 2 premature ventricular contractions). In thirty-nine patients (61%) the cardiac arrhythmia was abolished by the staff of the M.C.C.U.. Of the remaining 28 patients, 10 were brought to the hospital and 18 were left at home. None of these needed later admission to the hospital. So the treatment at home of cardiac arrhythmias has been successful in the majority of patients. Bunaftine was the antiarrhythmic drug more frequently used (23 cases, 34%) with a high percentage of success (87%). In planning medical emergency services to the community, one can envisage the use of the M.C.C.U. facilities to treat at home those arrhythmias that are not associated with an acute coronary attack.

Eighty-eight consecutive patients referred to a neurosurgical Department (63 men and 25 women) aged from 14 to 68 years, with cerebral ischemia in the carotid territory were subjected to M-mode and two-dimensional echocardiography, carotid angiography and assessment of risk factors. There were 27 patients (average age 54 years) in whom carotid angiography demonstrated a probable source for the ischemia. Carotid angiography was normal in 51 of the remaining 61 (average age 39 years) while 10 revealed distant emboli. Although the incidence of "abnormal echocardiograms" was similar in the two groups (56% and 54% respectively) the spectrum of abnormalities were different. Only 5 (18%) of the 27 patients with abnormal angiograms had a potential cardiac source of emboli while 24 (39%) out of the remaining 61 patients had a potential cardiac source demonstrated at echocardiography. There was a high incidence of mitral valve prolapse (34%) in this latter group of patients. Mitral valve prolapse was not seen in the present series in patients with a probable carotid source on angiography.

Congenitally corrected transposition of the great arteries is an unusual cardiac malformation with discordant atrioventricular and ventriculoarterial alignments. Because knowledge of the coronary artery anatomy is a prerequisite for successful repair of this cardiac anomaly, selective coronary arteriography was performed in 13 children (4 male and 9 female; age range 18 months to 16 years) and 1 adult (aged 59 years) with congenitally corrected transposition of the great arteries and associated intracardiac defects. The typical coronary distribution of corrected transposition (that is, coronary artery-ventricular concordance) was found in 11 patients. In one patient, a single coronary ostium was observed; the right sinus of Valsalva gave rise to a short common branch that divided into three arteries: a left circumflex artery going to the right, a well developed left anterior descending artery running into the anterior interventricular groove and a third vessel that continued on the normal course of the right coronary artery directed posteriorly. In one patient, the left circumflex artery was particularly small. In another patient, with severe hypoplasia of the left anterior descending coronary artery, the anterior ventricular wall of the heart was supplied by three small branches that ended a short distance from their origins. The adult patient had a large anterior ventricular branch arising from the morphologic left coronary ventricular as well as a large acute marginal branch, with a wide distribution, from the morphologic right coronary artery. Presurgical coronary angiographic documentation is helpful because, in congenitally corrected transposition as well as in complex congenital heart disease, coronary anomalies (in origin, course and distribution) are occasionally present and knowledge of their presence can help determine the most appropriate surgical approach.

A radioisotopic technique which, through the injection of 99mTc-red cell into the pulmonary artery, gives images of left ventricular chamber in RAO at first pass and in LAO at blood pool gated, has been assessed. A quantitative analysis of left ventricular wall motion was performed with semiautomatic program. The Authors report their experience with 30 CHD patients.

In patients with mechanical mitral prosthesis, the presence of dysfunction and regurgitation of the prosthesis may be difficult to assess by standard precordial color flow Doppler. Moreover, the kind of mitral prosthesis regurgitant jet is often impossible to determine. We have recently studied 4 patients with clinically suspected mitral prosthesis dysfunction. In all of them the conventional transthoracic color flow technique was unable to evidentiate prosthesis regurgitation, whereas the transesophageal color flow Doppler assessed a partial displacement with a peri-prosthetic regurgitation in 3 patients, and a prosthetic endocarditis with intra-prosthetic regurgitation in 1. All studies were performed using an Aloka SSD 860 and 5 MHz transesophageal color Doppler transducer, using a topical anesthesia with 10% lidocaine. The procedure was well tolerated without any complication in all patients. Transesophageal color flow Doppler has specific improved capabilities over transthoracic conventional color flow Doppler and represents an important advance even for the noninvasive evaluation of patients with suspected mitral prosthesis regurgitation.

A radioisotopic technique which, through the injection of 99mTc-red cell into the pulmonary artery, gives images of left ventricular chamber in RAO at first pass and in LAO at blood pool gated, has been assessed. A quantitative analysis of left ventricular wall motion was performed with semiautomatic program. The Authors report their experience with 42 patients.

The evaluation of the presence and severity of tricuspid insufficiency is still difficult even if many criteria of grading are available for different techniques. In this study the data obtained from Doppler mapping of the right atrium, from the analysis of the hepatic vein flow and from the contrast echocardiography of the inferior vena cava in 56 patients with mitral or mitral-aortic valvulopathy and with clinically suspected tricuspid insufficiency were submitted to the cluster analysis. This analysis was used to redistribute the study population according to the following parameters: diameter of the inferior vena cava, maximal systolic and diastolic flow of the hepatic veins, the length of regurgitant jet in right atrium and the duration of contrast in vena cava. The aim was to identify the variability range of each degree of severity. None of the analyzed parameters "per se" identifies the regurgitation severity because there is a large variability in the intermediate degrees. The cluster analysis shows a definite pattern of parameters for each cluster (1 = no significant regurgitation, 2 = mild, 3 = moderate, 4 = severe insufficiency).(ABSTRACT TRUNCATED AT 250 WORDS)

The patterns of valve motion were analyzed in 14 patients with combined aortic and mitral valve prolapse by two-dimensional echocardiography. Four patients have also tricuspid valve prolapse. In one we could find evidence of a myxomatous pulmonic valve with prolapse of the posterior cusp. By two-dimensional echocardiography all patients had redundant aortic leaflets bulging into left ventricular outflow tract during diastole. M-mode examination of the aorta was normal in five patients; eccentricity of the diastolic aortic valve echo was found in two patients; seven showed multiple echoes from the valve leaflets, with diastolic fluttering. The aortic valve was visualized in the left ventricular outflow tract during diastole in one patient. The size of the aortic root was normal in all. Six patients had transient ischemic cerebral attacks and no evidence of extracranial or intracranial vascular disease by angiography. As polyvalvular prolapse as demonstrated by echo suggest a myxomatous degeneration of the valves, we hypothesize that there may be a causal relationship between TIA and this type of pathological process.

The quantitative analysis of left ventricular shape in ischaemic heart disease has seldom been performed because of the lack of a reliable and reproducible method of analysis. Diastolic and systolic left ventricular outlines in two groups of patients with previous myocardial infarction (anterior in 13 cases and inferior in 14 cases) were studied by analyzing the regional curvature and the power spectrum. This method allowed us to obtain left ventricular curvatures from the mitral to the aortic corner and the power spectrum of the first 12 harmonics. The results obtained in these two groups were compared with those obtained in 16 normal subjects. The diastolic power spectrum in both infarcted groups was similar. It was characterized by a double peak which was different from that of the normal subjects. Slight differences between the two infarcted groups were due to the diverse amplitude of the highest harmonics. The regional analysis of the curvature in both groups showed similar abnormalities of the posterobasal, inferior and antero-basal regions. The posterior wall showed a uniform curvature with the point of minimum shifted towards the mitral corner; the anterior wall showed a rounded profile with a regular curvature. In the group with anterior myocardial infarction the curvature of the inferior wall was negative, i.e., convex towards the left ventricular cavity. The systolic power spectrum showed a double peak profile which was different from that of the normal subjects. There were some differences between the two groups as regards the first and the highest degree harmonics. In inferior myocardial infarction the apex was rounded whereas in the anterior one the most important abnormalities were the convexity of the inferior wall towards the inside and the presence of a region with minor curvature between two regions with greater curvature of the anterior wall. Some of the systolic abnormalities involved the probable site of the infarct while others were in remote regions. The meaning of remote abnormalities is not clear. However, we did not verify a correlation between wall motion, at least as shortening of radii, and regional curvature. The abnormalities of the diastolic outline were independent of the site of the infarct and did not appear to be correlated to end-diastolic pressure or to the ejection fraction. They seemed to be the morphological counterpart of the filling abnormalities reported in ischaemic cardiac disease and they may depend on the regional distribution of stresses.

Two distinct proteins endowed with succinate-semialdehyde dehydrogenase (succinate-semialdehyde:NAD(P)+oxidoreductase, EC 1.2.1.16) activity were separated and partially purified by ammonium sulphate fractionation or Sephadex G-200 gel-filtration or both. They differ by coenzyme specificity (NAD or NADP), molecular weight, temperature and pH resistance, pH-activity curves, beta-mercaptoethanol activation. Moreover, the NADP-specific enzyme catalyzes only the oxidation of succinate-semialdehyde among a number of aldehydes tested, whereas the NAD-specific form is active also towards n-butyraldehyde. The Km for the substrate is also appreciably different according to the coenzyme specificity, while the Km values for NAD and NADP are quite similar. Finally, the growth of the cells on gamma-aminobutyrate as the sole source of nitrogen resulted in enhanced level of the NAD-dependent succinate-semialdehyde dehydrogenase, with concurrent decrease of the alternate enzyme activity. On the basis of the above results, distinct metabolic roles are suggested for the two enzymes forms.

The high incidence of mitral valve prolapse (MVP) in patients with ischemic attacks is puzzling when compared with the very low incidence of cerebrovascular attacks observed in individuals known to have MVP. Our aim was to determine if it is possible to identify a patient subset with MVP at the highest risk of embolization on the basis of 2D-echocardiographic findings. We compared the echocardiographic picture of a group of 39 patients with MVP and cerebral ischemic attacks (29 TIAs, 10 strokes) in the carotid territory, without any pathological lesions at angiography, with that of a control group of 111 patients with MVP without neurological complications. The two groups were not different for age or sex. Patients with MVP and neurological complications showed a higher prevalence of aortic valve prolapse (62% vs 34%, p less than 0.01), of an association between valvular diffuse thickening and aortic valve prolapse (54% vs 23%, p = 0.001), and of multiple valve prolapse with valvular diffuse thickening (26% vs 7%, p less than 0.01) than those of the control group. This study suggests that in young people cerebral ischemic events could be related to the presence of a combined valve prolapse and to an echocardiographic picture of valve diffuse thickening. These data suggest that in this selected group with multiple valve prolapse and valvar diffuse thickening prophylaxis against embolic events by pharmacological preventive measures should be considered.