[The subclavian approach as an alternative to the femoral approach in selective cervicocephalic phlebography (author's transl)]. / L'abord sous-clavier comme alternative de la voie fémorale dans la phlébographie sélective cervico-céphalique.

The authors describe the technique employed for selective catheterization of the main mediastinal trunks and the veins of the brachiocephalic and cervicocephalic regions by means of the subclavian approach. The importance and advantages of this procedure as an alternative to the femoral approach, especially if this is contra-indicated, are emphasized.

[Evaluation of the seriousness of aortic valve stenosis: calculation of the valvular area or peak? Reliability of Hakki's formula]. / Valutazione della gravità della stenosi valvolare aortica: calcolo dell'area o gradiente al picco? Affidabilità della formula di Hakki.

The severity of aortic valve stenosis should be assessed by means of the calculation of the valvular area; on the other hand, the routine use of the Gorlin's formula for the aortic area is laborious and time consuming. Recently Hakki proposed a simplified formula (area = cardiac output/square root gradient) for the calculation of valvular areas. This method does not require the assessment of the systolic ejection time or the transvalvular flow; furthermore, the peak systolic gradient instead of the mean gradient may be entered into the formula. We have evaluated the reliability of this formula on 83 patients with aortic valve stenosis either pure or with absent to mild aortic incompetence (angiographically first degree maximum). Twenty-eight patients had isolated aortic stenosis, 55 had associated mitral stenosis and/or mitral or tricuspid regurgitation. Our results show a good correlation between the values of valvular areas obtained by Hakki's formula and those obtained by Gorlin's formula (r = 0.90 in the first group and r = 0.91 in the second group of patients). On the contrary we observed a poor relationship between the peak systolic gradient and the valvular area, with a considerable scatter of the data, especially for low values of peak systolic gradient. We therefore conclude that the assessment of the aortic valve stenosis must be based on the estimation of the valvular area; in our hands the Hakki's formula has proven to be easy and sufficiently reliable for routine diagnostic studies.

[Corrected transposition of the great vessels in the adult. Presentation of a case simulating ischemic cardiopathy]. / La trasposizione corretta dei grossi vasi nell'età adulta. Presentazione di un caso simulante la cardiopatia ischemica.

We report the clinical and laboratory findings in a 58 years old woman with corrected transposition of the great arteries (CTGA), who that presented typical angina pectoris. The diagnosis of ischemic heart disease was supported by the history of a previous myocardial infarction. Other findings were a systolic murmur of mild mitral regurgitation, left bundle branch block and enlarged left ventricle on the chest X-ray. Cardiac catheterization showed a corrected transposition of the great arteries (L-malposition with situs solitus); left and right coronary arteries were free of luminal stenosis. We suggest therefore that anginal chest pain may be due to myocardial ischemia induced by discrepancy between myocardial oxygen consumption and coronary blood flow. This complication may occur in patients with corrected transposition of great arteries surviving in adulthood.

[Development of a method for the quantitative evaluation of the regional kinetics of the left ventricle]. / Elaborazione di un metodo per la valutazione quantitativa della cenetica regionale del ventricolo sinistro.

Segmental wall motion abnormalities of the left ventricle frequently occur in ischemic heart disease. An objective, quantitative method is required to ensure the reproducibility of the assessment of left ventricular regional function, especially in evaluating the changes induced by diagnostic and therapeutic interventions. In 32 normal subjects we obtained 30 degrees right anterior oblique left ventriculograms and developed a method based on the following observations. The method should reflect the symmetric uniform motion of the left ventricular silhouette. Only actual contractile motion should be taken into account; therefore, rotatory and translational motion should be compensated for. Passive systolic movement of aortic and mitral valves accounts for the contraction of neighbouring myocardial segments. Left ventricular wall excursion is most often measured by a coordinate system: since the cavity of the left ventricle becomes relatively longer during systole, left ventricular walls contract neither toward a single central point nor toward the long axis; therefore the appropriate origin of the coordinate system will be a segment. Furthermore, as more elongated left ventricular end-diastolic silhouettes appear to show a greater extent of systolic lengthening (we show evidence of this), the length of the segment must be related to the end-diastolic shape. The basic steps of the method are: 1) identification of a symmetry line, from the aortic mid-point to the apex, by connecting the mid-point of 19 diameters perpendicular to the long axis; 2) roto-translation of the end-systolic silhouette so that the end-systolic apex and aortic mid-point lie on the symmetry line.(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute dissection of the thoracic aorta. Proposal of a new surgical technic]. / La dissezione acuta dell'aorta toracica. Proposta di una nuova tecnica chirurgica.

Acute aortic dissection is a challenging surgical disease. Replacement of the supracoronary aorta alone can be followed by recurrent aneurysm formation at the level of the residual aortic root. The Bentall procedure prevents this late complication but intraoperative haemorrhage may be severe and valve replacement is always mandatory. A new surgical technique is presented which has been adopted in seven consecutive patients with no deaths. With this procedure, strengthening of the aortic root is obtained by inserting three Dacron Double Velour patches "between" the internal and external aortic lamina, one for each sinus of Valsalva. The patches override the coronary ostia which are left wide patent, and are anchored directly to the aortic anulus by single mattress sutures which reduce the size of the anulus. Suspension of the valve leaflets to the patches overriding each other at the commissures together with anuloplasty reestablish valve continency. The two aortic stumps are secured with running sutures over the free edge and a tubular Dacron graft is then anastomosed to them. The procedure reinforces the aortic root, will prevent recurrent aneurysm formation and avoids at the same time valve replacement, when unnecessary, and coronary arteries reimplantation.

[Selective catheterization of cervical and mediastinic veins by subclavian approach (author's transl)]. / Tecnica della flebografia selettiva cervico-mediastinica per via succlavia.

The authors present the selective catheterization of the veins of the neck and mediastinum via the subclavian vein. Benefits and complications of the technique are discussed. The subclavian approach is very helpfull and technique of choice when the femoral route is not available.