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There is general agreement that left-sided elastomas must be removed to avoid systemic complications. Right-sided localization is less risky and surgical treatment is not agreed upon. We report a case of surgical resected fibroelastoma of the tricuspid valve and discuss the indications to surgery by reviewing the literature on the few reported cases. We feel that, if surgery is timely, the tumor can be resected, thus preserving the native valve. This provides an opportunity to prevent possible right-sided complications due to increasing tumor size and embolization.

The aim of the present study was to assess structural characteristics of the left ventricle by echocardiography in a group of patients with Cushing's syndrome compared with a control population. Eighteen patients with Cushing's syndrome and 18 controls, matched for sex, age, body weight, body surface area, blood pressure (BP) and duration of hypertension were investigated by M-mode (2-D derived) echocardiography. In each of the two groups, 11 of 18 subjects were hypertensive. Relative wall thickness (RWT) was above normal (> 0.45) in 11 (five normotensive and six hypertensive) of 18 patients with Cushing's syndrome and in two (hypertensive) of 18 controls. Left ventricular mass index was abnormal in three (one normotensive and two hypertensive) patients with Cushing's syndrome and in four hypertensive controls. All other systolic function indices were within normal and similar in both groups. No correlation was found between RWT and BP as well as between RWT and urinary cortisol levels in patients with Cushing's syndrome. A significant correlation was found between RWT and duration of disease. Echocardiography after successful surgery showed normalisation of RWT in five of six patients in whom it was previously abnormal. Our data suggest that time factor, i.e. long-lasting exposure to increased cortisol, rather than hormone or BP levels is the most relevant determinant of left ventricular concentric remodeling in patients with Cushing's syndrome.

The relation between three-dimensional geometry of the inflow tract to the orifice and the area, shape, and velocity of regurgitant jets was studied in a pulsatile in vitro color Doppler flow model. A 2.5 MHz transducer connected to a diagnostic ultrasound machine was placed in a water tank facing pulsatile jets (duration, 0.5 second) obtained by a calibrated injector. Flow rate from 6 to 52 ml/sec were tested through a 5 mm diameter circular orifice. Four different three-dimensional inflow tract geometries were compared: (A) sharp-edged, (B) Venturi (funnel), (C) converging conical, and (D) diverging conical. Mean velocities of jets were measured by continuous-wave Doppler echocardiography. Driving pressures were also measured by means of a fluid-filled catheter. Two observers independently digitized contours of maximal color jet areas by computer system from two separate sets of experiments. Results are given as the mean values of the four measurements for each parameter. Jet areas were correlated to flow rate, with no difference from A through D. The shape (eccentricity) of jets was different between A and B (p less than 0.05), between B and D (p less than 0.01), and between C and D (p less than 0.01). The shape of jets was correlated with flow rate, continuous-wave velocity, and pressure gradient in B, C, and D but not in A. Measured pressure gradients and estimated gradients by continuous-wave Doppler echocardiography were similarly correlated from A through D.(ABSTRACT TRUNCATED AT 250 WORDS)

A small amount of fluid in the pericardial sac is often observed incidentally during upper abdomen US studies. In order to assess the normality range for this finding, 500 patients undergoing liver US were evaluated for the presence of pericardial fluid, the thickness of which was subsequently measured in positive cases. In a group of 20 patients with pericardial fluid thickness ranging 5-9 mm and in 6 cases with pericardial effusion greater than 10 mm, cardiologic evaluation was performed (clinical examination, ECG, echocardiography). Pericardial fluid was quite a common finding (20.8%) which had no clinical relevance when less than 10 mm. On the contrary, its clinical relevance was high when greater than 10 mm, and extending around the heart.

We report the results of percutaneous transluminal coronary angioplasty (PTCA) in 67 consecutive patients with unstable angina. Twenty patients had new onset (less than 2 months) angina, 33 patients had crescendo angina and 14 had early postinfarction angina. Fifty-one patients had one-vessel disease, 12 patients had two-vessel disease and two patients had three-vessel disease; two patients had a stenosis of a venous graft. In cases with multivessel disease, we performed only the dilatation of the ischaemia-related vessel identified by morphologic features of coronary lesion and electrocardiographic changes during chest pain. The procedure was successful in 54 cases (80.6%). Seven patients (10.4%) had major complications. Emergency coronary artery bypass graft surgery was performed in 6 cases (8.9%) because of occlusion of the left anterior descending artery; despite emergency operation one patient died and two patients sustained a myocardial infarction. One patient had occlusion of the right coronary artery and inferior myocardial infarction. In all patients in whom angioplasty was successful unstable angina disappeared. At 6 months follow-up there were no infarctions or deaths but 14 of 42 patients (33%) had recurrent angina. Restenosis occurred in 16 of 33 patients (48%) who had repeat coronary angiography. Four patients with recurrence of unstable angina had repeat angioplasty; it was successful in 3 cases. One patient died of refractory cardiac arrest. The mortality rate of 71 procedures performed in 67 patients was 2.8% (2/71) and the overall myocardial infarction rate was 4.2% (3/71).(ABSTRACT TRUNCATED AT 250 WORDS)