Left ventricular remodeling and mechanics after successful repair of aortic coarctation.

Forty normotensive patients (mean age 12.3 +/- 6.5 years) followed up after a successful repair of aortic coarctation (mean age at coarctectomy 5.1 +/- 4.8 yrs) were studied by echo-Doppler to (1) evaluate left ventricular (LV) remodeling and endocardial and midwall mechanics, and (2) identify factors that might predispose to persistent abnormalities. Sex- and age-specific cutoff levels for LV mass/height2.7 and relative wall thickness were defined to assess LV geometry. To adjust for age-and growth-related changes in ventricular mechanics, all echocardiographic variables were expressed as a Z-score relative to the normal distribution. In addition, the smallest diameter of the aorta was assessed by magnetic resonance imaging and calculated as percent narrowing compared with the diameter of the aorta at the diaphragmatic level. In the study group, 24 of 40 patients (60%) had normal LV geometry. Among the 16 patients (40%) with abnormal LV geometry, 5 (12.5%) had a pattern of concentric remodeling and 11 (27.5%) an eccentric hypertrophy. LV hypertrophy was marked (LV mass index >51 g/m2.7) in 5 of these patients. No patient had a pattern of concentric hypertrophy. LV contractility was increased (Z-score >95th percentile) in 28 patients (70%) as assessed using the endocardial stress-velocity index. In contrast, LV contractility assessed using midwall stress-velocity index remained elevated (Z-score >95th percentile) in 15 patients (37.5%). The stepwise multiple logistic regression analysis was not able to detect any significant independent predictor of abnormal LV remodeling, including sex, age at surgical repair, length of postoperative follow-up, heart rate, body mass index, systolic and diastolic blood pressure, and smallest diameter of the aorta, as well as indexes of LV geometry (shape, mass, volume, mass/ volume ratio) and function (preload, afterload, pump function, and myocardial contractility). Thus, normotensive patients after surgical repair of aortic coarctation may be in an LV hyperdynamic cardiovascular state (more frequent in those who have undergone late repair) and have multiple patterns of LV geometry.

Cardiovascular effects of long-term L-thyroxine therapy for Hashimoto's thyroiditis in children and adolescents.

Morphology and function of the left ventricle were evaluated by echo and Doppler examination in 16 females affected by Hashimoto's thyroiditis, aged 13.3 (4.5) years (range 7.9-24.6). They were on L-thyroxine (L-T4) treatment for a period of 2.8 (2.8) years (range 0.8-7.6) with a mean daily dose of 77 (18) micrograms/m2. Left ventricular mass, systolic and diastolic function, cardiac output and systemic vascular resistance did not differ from a control group matched for age, sex and body size. A further analysis of the patients according to thyrotrophin serum levels (less or more than 0.1 mU/l) gave similar results. Moreover, no relationship was found between echocardiographic findings and age, L-T4 daily doses, duration of treatment and serum level of thyroid hormones. We can therefore conclude that chronic L-T4 treatment for Hashimoto's thyroiditis at the given doses did not affect cardiac function and morphology in children and adolescents; however, a longer follow-up is needed before confirming the safety of this therapy in the long term.

[Corrected transposition of the great arteries in geriatric age. Report of a case diagnosed by magnetic resonance imaging]. / Trasposizione corretta delle grandi arterie riscontrata in età geriatrica. Descrizione di un caso ed apporto diagnostico della risonanza magnetica.

Corrected transposition of the great arteries (cTGA) is a rare condition, and few patients with this abnormality survive the 50th year of age because of associated anomalies or the subsequent development of left atrioventricular valve regurgitation or heart block or both. We report the case of a 75 years old man with cTGA without associated anomalies which seems to be of particular interest because of the following reasons: 1) cTGA is a rare condition in advanced age; 2) the diagnosis has been made by MRI which allowed a complete segmental analysis; 3) this case confirms that the morphologic right ventricle in systemic position can function appropriately over a long term. We conclude that MRI can be an alternative to Echocardiography in patients with complex congenital cardiac disease who exhibit a poor ultrasound window.

[Myocardial involvement in granulomatous vasculitis (Churg-Strauss disease)]. / Compromissione miocardica in corso di vasculite granulomatosa (malattia di Churg-Strauss).

We report the case of a 44-year-old woman affected by Churg-Strauss syndrome (systemic vasculitis with eosinophilia, bronchial asthma and pulmonary infiltrations). Congestive heart failure developed, caused by severe myocardial and pulmonary involvement. Conventional treatment and steroids induced remission of symptoms.

Age-related variation in left ventricular myocardial contractile state expressed by the stress velocity relation.

The assessment of ventricular function plays an important role in the pre- and postoperative management of many congenital heart abnormalities. Normal ranges in left ventricular systolic function indices have been defined during childhood and age-related alterations in left ventricular myocardial contractile state have recently been reported. This study was carried out to investigate the developmental changes in left ventricular contractile state expressed by the endsystolic meridional stress (ESS)/rate-corrected velocity of circumferential fiber shortening (VCFc) relation, calculated by echo in normal children and young adults. We examined 146 healthy subjects (80 males and 66 females), mean age 70.85 +/- 63.89 months (range 0.5-228) and body surface area (BSA) 0.807 +/- 0. 47 (range 0.18-2.01) with no clinical and echocardiographic evidence of cardiac disease and with normal blood pressure. The subjects were divided into three groups according to age: <6 months (group 1, n = 32), 6-36 months (group 2, n = 34), and >36 months (group 3, n = 80). Enddiastolic volume and mass (M) of the left ventricle were measured by M-mode Echo. ESS was considered as an index of afterload and the VCFc as an index of systolic ventricular function. The left ventricular ejection time used for the calculation of VCFc was measured from aortic flow obtained by PW-Doppler. The ESS/VCFc relation was used to assess left ventricular contractility. Systolic blood pressure, volume, and mass of the left ventricle increase with age. The gradual increase in pressure despite a stable mass/volume ratio [M/V = 0.900 + (0.0007 x age); r = 0.27, p < 0.005] resulted in a substantial increase of afterload [ESS = 29.78 + (0.116 x age); r = 0.58, p < 0.0001]. VCFc showed an inverse hyperbolic regression with afterload [VCFc = 1.01 + (7.598/ESS); r = 0.59, p < 0.0001]. The regression lines (best linear fit) between VCFc and ESS are significantly different in the three groups. The Y intercept was higher and the slope steeper in group 1 [VCFc = 1.74 - (0.017 x ESS); r = 0.65, p < 0.0005] vs group 2 [VCFc = 1.54 - (0.008 x ESS); r = 0.58, p < 0.001] and group 3 [VCFc = 1.52 - (0.007 x ESS); r = 0.57, p < 0.0001]. These data indicate that, in children, the volume and mass of the left ventricle increase, whereas the M/V ratio remains relatively constant; the progressive increase in arterial blood pressure explains the increase of afterload. The VCFc is higher in the first few years of life compared to that seen in older children due to reduced afterload and increased contractile state. Left ventricular contractility, expressed as ESS/VCFc relation, is thus inversely proportional to age. In the first months of life the left ventricular myocardium exhibits a higher basal contractile state and a greater sensitivity to changes in afterload. For obtaining an accurate assessment of left ventricular function, the ESS/VCFc relation in different age groups should be measured.

[The utility of various Doppler parameters at rest and during exercise for the diagnosis of residual stenosis after operation for aortic coarctation. A doppler-nuclear magnetic resonance comparison]. / Utilità di diversi parametri Doppler a riposo e da sforzo nella diagnosi di stenosi residua nella coartazione aortica operata. Studio di confronto Doppler-risonanza magnetica nucleare.

BACKGROUND: The postoperative follow-up of aortic coarctation (AoCo) is often characterized by persistent arterial hypertension, sometimes due to a residual narrowing at the site of surgical repair. A residual stenosis > or = 30% is considered to be significant. Anatomy of the aortic arch is best assessed by angiography, transesophageal echocardiography and magnetic resonance imaging (MRI). The use of these invasive and expensive procedures for routine examination in all patients who develop late systemic hypertension cannot be justified. Consequently, it would appear to be useful to find some noninvasive methods, such as Doppler gradients, that are capable of identifying any residual anatomic narrowing. OBJECTIVES: We compared different Doppler parameters obtained at rest and during exercise with the degree of narrowing at the site of surgical repair measured by MRI, in order to identify the indices predictive of residual stenosis. METHODS: Thirty-nine patients (26 M, 13 F) were studied after AoCo repair. Mean age was 21.7 +/- 9.7 years (9-49). Their age at the time of repair was 10 +/- 9.7 years (0.1-27) and the postoperative follow-up was 11.5 +/- 6 years (2-25). Systolic blood pressure measurement and Doppler echo for calculation of the transisthmic gradient at rest and during exercise on a bicycle ergometer were performed in all patients. The peak systolic gradient (PGs) over the isthmus was calculated using the simplified Bernoulli equation: PGs = 4 x (V2(2)-V1(2)), where V1 and V2 are the peak velocities in the ascending and descending aorta. In addition, at the end of exercise the peak diastolic gradient (PGd) was measured at the end of the T wave on the ECG, and the systolic velocity half-time (SVHT), as the time interval from the peak to the half peak systolic velocity. MRI of the aorta was performed to measure the diameter of the isthmus (AI) and of the descending aorta at the diaphragm (DA). Residual narrowing at the isthmus was expressed as stenosis % = [(1-(AI/DA)]%. RESULTS: At rest: systolic blood pressure 128.3 +/- 22.5 mmHg, PGs 15.9 +/- 8.1 mmHg (1-32). None of the patients had PGd. At peak exercise: systolic blood pressure 207 +/- 37 (160-265) mmHg, PGs 32.3 +/- 14.7 mmHg (8-70), SVHT 96 +/- 23 msec (60-139) and PGd 7.2 +/- 4.8 mmHg (1-17). Stenosis % measured by MRI was 23.1 +/- 14.5% (0-53) and in particular, it was < 30% in 25 patients and > or = 30% in 14 patients. Both the PGs at rest and the other Doppler parameters at peak exercise (PGs, SVHT, PGd) correlated with stenosis %. SVHT together with PGd on exercise Doppler represented the combination of two variables that was best for predicting a residual stenosis. When all three variables obtained by exercise Doppler were combined, every patient with residual stenosis was correctly identified. In particular, the combination (PGs > or = 28 mmHg + SVHT > or = 108 msec + PGd > or = 8 mmHg) identifies all patients with stenosis > or = 30%, while the combination (PGs < or = 38 mmHg + SVHT < 108 msec + PGd < 10 mmHg) excluded those with significant stenosis. CONCLUSION: Parameters obtained from the transisthmic gradient (PGs, SVHT, PGd) measured at peak exercise by CW-Doppler can diagnose a residual stenosis % in operated AoCo. We propose using this noninvasive method of identifying patients who need to be referred for MRI.

[Immediate results of percutaneous mitral valvuloplasty using Inoue catheter. Personal experience in the first 15 cases]. / Risultati immediati della valvuloplastica mitralica percutanea con catetere di Inoue. Esperienza personale nei primi 15 casi.

Mitral valvuloplasty with an Inoue balloon catheter was performed at our institution in 15 patients affected by mitral stenosis. All were severely symptomatic (class NYHA III or IV). Transthoracic and transesophageal echocardiography showed a mitral score less than 10 (Wilkins criteria). Patients with thrombi in the left atrium and those with important mitral regurgitation were excluded. The mitral valve area increased from 0.98 +/- 0.2 to 1.89 +/- 0.4 cm2 and the transvalvular gradient decreased from 18.2 +/- 7.5 to 6.7 +/- 3.7 mmHg. There was a small increase of the mitral regurgitation. Two complications occurred during the procedure: the first was a haemopericardium, which was percutaneously drained, and the other a rupture of the anterior mitral leaflet with acute, severe mitral regurgitation necessitating urgent surgical correction. Applying the criteria of Herrmann, the results were optimal in 11 and suboptimal in 3 cases.

[The adenosine test in association with 99m-technetium sestamibi tomoscintigraphy in the diagnosis of coronary pathology]. / Il test all'adenosina associato alla tomoscintigrafia con 99m-tecnezio-sestamibi nella diagnosi di coronaropatia.

BACKGROUND: The exogenous adenosine is able to provoke a coronary vasodilation, which is the same as the one provoked by the papaverine and greater than the one provoked by the dipyridamole. We report our experience in using exogenous adenosine in association with technetium-99m-sestamibi tomoscintigraphy for a diagnostic test on the coronary artery disease (CAD). METHODS: We considered 22 patients (18 male and 4 female, mean age 57 years) affected by angiographically demonstrated coronary artery disease (stenoses > or = 50%). Adenosine was infused at a dosage of 0.070 mg/kg/min for 3 minutes and, if well tolerated, the dosage was increased to 0.140 mg/kg/min; in the third minute of the major dosage the radioisotope was injected. The myocardial perfusion imaging at rest was evaluated on the following day. RESULTS: The test was completed on 21 of the 22 patients, and 20 of the latter were subjected to the maximal dosage of the adenosine infusion. Clinically irrelevant adverse effects were observed in 20 cases; only one patient developed a II degree type 1 AV block. Angina occurred in 19 patients. Coronary angiography demonstrated significant stenosis of 35 vessels: the left anterior descending (LAD) in 14 patients, the left circumflex (LCx) in 8 and the right coronary artery (RCA) in 13. In detecting CAD, the test in our study demonstrated a sensitivity of 85% in the LAD disease, of 89% in the LCx disease and of 77% in RCA disease. CONCLUSIONS: The adenosine infusion associated with technetium-99m-sestamibi tomoscintigraphy demonstrated an elevated incidence of adverse effects which are of short duration and clinically irrelevant. The method was shown to be highly sensitive in detecting the CAD.

[The value of nuclear magnetic resonance tomography in evaluating the patency of aortocoronary bypass grafts]. / Die Wertigkeit der Kernspintomographie bei der Beurteilung der Durchgängigkeit von aortokoronaren Grafts.

BACKGROUND: Patients with previous coronary artery bypass graft surgery often present with pain of unknown origin. Noninvasive documentation of graft patency is of obvious clinical importance. METHODS: In order to assess the efficacy of magnetic resonance imaging (MRI) in evaluating graft patency, 44 patient with prior coronary artery bypass graft surgery and a history of chest pain were studied by coronarography and MRI. MRI was performed within 2.1 +/- 3.8 days from coronarography using a 0.5 Tesla magnet, Spin-Echo T1 technique, cardiac and respiratory gating and scannings in transaxial plans. A graft was defined as patent, if a signal void was identified in at least two different slices in a position consistent with a bypass graft. Images were analyzed by two different observers aware of the type of surgery but not the result of the coronarography. RESULTS: Eighty-nine out of 100 grafts were classified correctly by MRI. Sixty-three grafts were patent as shown by coronarography; 59 of them were classified correctly by MRI. Thirty-seven grafts were shown as occluded; 30 of them were classified correctly by MRI. In particular, 43 out of 45 grafts to the left anterior descending artery, 18 of them using the internal mammary artery, 23 out of 30 graft to the left circumflex artery and 23 out 25 grafts to the right coronary artery were classified correctly. CONCLUSIONS: This study demonstrates the capability of MRI to evaluate coronary artery bypass graft patency with a sensitivity of 94% and specificity of 81%; this technique has significantly clinical limitations because resolution is not adequate to evaluate the presence of graft stenosis.

[Value of the isovolumetric index in the diagnosis of ischemic cardiopathy with normal left ventricular volume and ejection fraction]. / Valore dell'indice isovolumetrico nella diagnosi di cardiopatia ischemica con volumi e frazione di eiezione ventricolare sinistra normali.

Purpose of this study was to assess if the isovolumic index (IVI%) was able to detect the presence of critical coronary artery disease (CAD) in a group of 43 patients with anginal chest pain and normal left ventricular volumes and ejection fraction. The left ventricular function was before evaluated with invasive method and then the IVI% was allowed in every patient. The IVI% was able to recognize early abnormalities of isovolumetric phases of the left ventricle and differentiated normal subjects (IVI% = 40.07 +/- 2.82) from patients with CAD (IVI% = 60.87 +/- 12.49; p less than 0.01). The only parameter of left ventricular function invasively calculated able to separate normal patients from patients with significant CAD were the muscular stiffness of the left ventricle (p less than 0.01).

[The isovolumetric index: a new index of left ventricular function]. / L'indice isovolumetrico: un nuovo indice di funzione ventricolare sinistra.

The isovolumic index (IVI%), a new parameter of left ventricular function defined as (isovolumic contraction + isovolumic relaxation time)/left ventricular ejection time, is easily obtained from a routine echocardiogram. By simultaneous recordings of an electrocardiogram, a carotid arterial pulse tracing and the mitral valve echocardiogram, we calculated the IVI% as (time from R wave to MV opening-LVET)/LVET %. 90 normal subjects, mean age 38.32 +/- 11.8 years (range 20-60), underwent an echocardiographic study in order to calculate this index. The value of the IV% was 39.75% +/- 6.82 (range 21.4%-52.3%). The index was heart rate independent and showed a weak positive correlation with age (y = 32.4 + 0.19x; r = 0.33; p less than 0.01). The intraobserver and interobserver variability were 2.6% and 3.6%. The methodologic aspects of the calculation of the IVI% are discussed.

Cardiac performance in Turner's syndrome patients on growth hormone therapy.

OBJECTIVES: To investigate possible cardiac morphofunctional alterations observed in 26 Turner's syndrome (TS) patients on prolonged high-dose growth hormone (GH) therapy. STUDY DESIGN: We examined 26 TS subjects treated with rhGH (1 U/kg/week) for a mean period of 4.9 years (range 1-7.8) and 37 age-, weight- and height-matched healthy girls. Left ventricular volume, mass, systolic function, cardiac index, systemic vascular resistance and diastolic function were evaluated by two-dimensional and Doppler echocardiography. RESULTS: Heart rate and systolic blood pressure (BP) were higher in TS patients than in controls, while diastolic BP was lower. Left ventricular volumes, ejection fraction, mass index, M/V ratio and cardiac index did not differ significantly; systemic vascular resistance was slightly decreased. Left ventricular fractional shortening and mean velocity of circumferential shortening were slightly increased while end-systolic meridional stress was decreased in TS. Contractile state was normal in TS. Diastolic function assessment showed a shortening of isovolumetric relaxation and diastolic filling times with an increased atrial contribution and a normal pulmonary venous flow. CONCLUSION: Cardiac morphology in TS patients on GH therapy is similar to controls. The observed changes in left ventricular systolic and diastolic function should be interpreted as an adaptation to the higher heart rate and reduced peripheral vascular resistance induced by GH therapy.

[Quantitative evaluation of left ventricular systolic function using bidimensional echocardiography: comparison with cineangiography]. / Valutazione quantitativa della funzione sistolica ventricolare sinistra con ecocardiografia bidimensionale: confronto con cineangiografia.

The aim of the study was to compare the evaluation of the left ventricular systolic function performed both by angiography and 2D-echocardiography on 80 subjects (31 with coronary artery disease, 18 with left ventricular volume overload, 10 with left ventricular pressure overload, 14 with mitral valve disease and 7 normal controls). The 2D-echocardiograms of the left ventricle with simultaneous measurement of the right arm systolic blood pressure was performed within 24 hours of the angiographic examination. The following parameters were obtained using the two methods: end-diastolic volume index, end-systolic volume index, ejection fraction, left ventricular mass index, mass/volume ratio, end-systolic circumferential stress, contractility expressed as end-systolic circumferential stress/end-systolic volume ratio; the end-systolic circumferential stress/ejection fraction ratio was calculated only by 2D-echocardiography. The afterload and contractility were not calculated in subjects with coronary artery disease and left ventricular outflow gradient. No statistically significant differences were shown between the two methods, except a slight under-estimation by echocardiography of the angiographic end-diastolic volume index (93.1 +/- 38.9 ml/m2 vs 115 +/- 39.9 ml/m2; p less than 0.01) and over-estimation of the mass/volume ratio (1.38 +/- 0.33 g/ml vs 1.2 +/- 0.44 g/ml; p less than 0.01) was shown between the two methods for all parameters. A depressed contractile state was also demonstrated by the end-systolic circumferential stress/ejection fraction ratio. The inter and intraobserver variability was 6.6 +/- 4.4% (range 0.16%) and 4.2 +/- 3% (range 1.11%) respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

[Role of echo-doppler in programming of sequential pacemakers. Evaluation of optimal atrioventricular delay in patients with normal or hypertrophic left ventricle]. / Ruolo dell'ecodoppler nella programmazione dei pacemaker sequenziali. Valutazione del ritardo atrioventricolare ottimale in pazienti con ventricolo sinistro normale o ipertrofico.

2D-echocardiography, together with simultaneous measurement of systolic blood pressure and pulsed doppler examination of the transmitral flow were used to assess the left ventricular (LV) systolic and diastolic function during sequential pacing at 4 different atrioventricular (AV) intervals (50, 100, 150, 200 msec), and VVI pacing under the same rate of 90 beats/min in 13 patients (pts), mean age 61.25 +/- 8.26 years with DDD pacemakers implanted for complete AV block. The pts were divided into 2 groups: group I was comprised of 7 subjects showing no clinical abnormalities and normal echocardiograms, and group II of 6 hypertensive subjects with LV hypertrophy and normal systolic function on echocardiography. There was no change in LV diastolic dimension, but a depression in LV systolic function and contractility were shown by the conversion from DDD to VVI pacing in all pts, particularly in group II VVI pacing caused mitral regurgitation with LV filling pattern changing from beat to beat. By changing the AV interval during DDD pacing, the LV filling pattern was modified in all pts. Systolic performance showed little change in group I, whereas in group II more evident modifications were seen. An optimal AV delay, defined as the delay with maximal stroke volume, was identified in all subjects as being 100 and 150 ms in group I and group II respectively. Echo-doppler can thus provide useful information in choosing the mode of pacing and in programming optimal AV delay. In contrast to normal ventricles the systolic performance in hypertrophic ventricles is highly influenced by variation in the AV delay.(ABSTRACT TRUNCATED AT 250 WORDS)

[Developmental changes of cardiac mechanics during fetal and postnatal life. Diagnostic role of Doppler echocardiography]. / Modificazioni evolutive della meccanica cardiaca durante la vita fetale e postnatale. Ruolo diagnostico dell'eco-Doppler.

The advent of fetal echocardiography combined with Doppler technology gave the clinicians the possibility to evaluate and clarify the main aspects of fetal and postnatal circulatory physiology. From the end of cardiogenesis to the end of gestation the developmental changes of the fetal myocardial structure, ventricular function and circulatory physiology have all been studied. Also the physiological features of the transitional circulation in the first postnatal period, as well as the developmental changes in the morphology and function of the neonatal ventricles can be assessed by Doppler echocardiography. This review is divided in two parts. In the first one we will briefly discuss the contractile properties of the fetal myocardium, the cardiac performance and dynamics of the fetal circulation; in the second one we will consider the physiological aspects of the transitional circulation, the structural features of the immature neonatal myocardium, as well as the developmental changes of the myocardial mechanics as shown by Doppler ultrasound.

[Value of mono- and bi-dimensional contrast echocardiography in the diagnosis of inter-atrial defect with left-to-right shunt]. / Valore dell'ecocontrastografia mono e bidimensionale nella diagnosi di difetto interatriale con shunt sx-dx.

Thirteen patients with atrial septal defect (ASD), 12 ostium secundum type, 1 ostium primum type and left-to-right shunt were studied by M-mode and two-dimensional echocardiography and then by intravenous contrast study. Diagnostic confirmation was obtained in 12 cases by cardiac catheterization and angiocardiography. The purpose of the study was to assess the value of contrast echocardiography in the diagnosis of ASD without pulmonary hypertension, since it is known that the standard echocardiographic investigation is rather unsatisfactory in this type of malformation. M-mode echocardiography with contrast injection has been diagnostic in 12 cases (92.3%), by visualising contrast echos in the mitral tunnel. The overall reliability of the two-dimensional contrast-echocardiography was reduced in our cases by a fairly high number of inaccurate results. The right to left shunting of injected contrast does not seem to depend on the haemodynamic parameters considered, such as right atrial pressure, right ventricular end-diastolic pressure, pulmonary artery pressure, and pulmonary arteriolar resistance.

[A contribution to the electrogenetic interpretation of left ventricular hypertrophy caused by volume overload]. / Contributo all'interpretazione elettrogenetica della ipertrofia ventricolare sinistra da sovraccarico di volume.

The purpose of the present study is to make a contribution to the understanding of the electrogenetic interpretation of left ventricular hypertrophy caused by volume overload. Thirty-two cases of isolated aortic valve regurgitation with electrocardiographic evidence of left ventricular hypertrophy were studied by vectorcardiography in order to measure the 20 msec vector both in the spatial and horizontal plane, and by M-Mode echocardiography to obtain the interventricular septal and posterior wall thickness and the end diastolic dimension of the left ventricle. The following relations were analyzed: a) between the interventricular septal thickness and the amplitude of the 20 msec vector in the spatial and horizontal plane; b) between the end diastolic dimension of the left ventricle and the amplitude of the 20 msec vector. We also explored the possibility to distinguish by means of the 20 msec vector amplitude between patients with and without disproportionate septal thickening. We found no correlation either between interventricular septal thickness and amplitude of the 20 msec vector, or between left ventricular end diastolic dimension and amplitude of the 20 msec vector. It was not possible to distinguish by means of the amplitude of the 20 msec vector between the cases of left ventricular hypertrophy with disproportional septal thickening and those without it.

[Acute myocardial infarction in a young adult with multiple coronary aneurysms resulting form Kawasaki disease]. / Infarto miocardico acuto in giovane adulto con aneurismi coronarici multipli da esiti di malattia di Kawasaki.

A young male patient with no risk factors for atherosclerotic disease suffered from an acute myocardial infarction at the age of 22 years, and was subsequently found to have multiple coronary artery aneurysms by coronary angiography. The transthoracic echocardiography was unable to identify coronary anomalies, whereas the transesophageal approach did show aneurysmatic lesions of the left anterior descending artery. These could have been caused by a previous episode of Kawasaki disease, a pathological finding that should be considered in any young adult presenting with proximal discrete coronary artery aneurysms.

Medium-term cardiovascular effects of high-dose growth hormone treatment in growth hormone-deficient children.

AIM: To investigate the possible cardiac morphofunctional alterations inducd by prolonged and high-dose GH therapy in a group of 14 children with isolated GH deficiency. PATIENTS AND METHODS: Patients were evaluated at phase 1, after 1.1 +/- 0.6 years of treatment with GH 0.93 +/- 0.13 U/kg/week, and at phase 2, after 5.5 +/- 2.1 years of therapy 0.89 +/- 0.11 U/kg/week. At each phase left ventricular volume, mass and systolic function were evaluated by two-dimensional guided M-mode echocardiography; left ventricular diastolic function was assessed by PW-Doppler sampling of transmitral flow. RESULTS: Phase 1: diastolic blood pressure was lower (p < 0.05) and fractional shortening was not adequate for the level of afterload (stress shortening index p < 0.05) in patients compared to controls. Phase 2: diastolic blood pressure was lower (p < 0.01) and mass and mass/volume ratio were increased (mass index p < 0.05, mass/ volume ratio p < 0.05) in patients compared to controls. The increased mass/volume ratio, together with the normal systolic blood pressure, explains the reduction in peak systolic stress (p < 0.005). Among the parameters of left ventricular diastolic function, the peak E velocity/total area under mitral valve tracing and the area under E velocity/total area under mitral value tracing ratios were significantly decreased (p < 0.05). CONCLUSION: After a mean period of 5 years on high-dose GH treatment in GH-deficient children, subclinical morphofunctional alterations in the left ventricle were found.

[Magnetic resonance with the spin-echo technic in the noninvasive evaluation of the patency of aortocoronary bypasses: preliminary data]. / La risonanza magnetica con tecnica spin-echo nella valutazione non invasiva della pervietà dei bypass aorto-coronarici: dati preliminari.

BACKGROUND: Patients with previous coronary artery bypass graft surgery often develop chest pain due to ischemic or nonischemic causes. Noninvasive evaluation of graft patency is thus of obvious potential importance. METHODS: In order to assess the efficacy of magnetic resonance imaging (MRI) in evaluating graft patency after coronary artery bypass graft surgery, 16 patients with prior surgery and history of chest pain were studied prospectively by coronarography and MRI. These 16 patients with a total of 40 grafts were evaluated, using MRI with Spin-Echo T1 technique within 3.6 +/- 4.4 days from coronarography with a 0.5 Tesla magnet, cardiac and respiratory gating and scannings in transaxial planes. A graft was defined as patent if a signal void was identified in at least two different slices in a position consistent with a bypass graft. Images were analyzed by two different observers aware of the type of surgery but not the result of the coronarography. RESULTS: Thirty-six out of the 40 grafts were classified correctly by MRI. Twenty-eight grafts were patent as shown by coronarography; 26 of them were classified correctly by MRI. Twelve grafts were shown as occluded; 10 of them were classified correctly by MRI. In particular, all of the 14 grafts to the left anterior descending artery (3 of them using the internal mammary artery), 13/16 of the grafts to the left circumflex artery and 9/10 of the grafts to the right coronary artery were classified correctly. CONCLUSIONS: This study demonstrates the capability of MRI to evaluate coronary artery bypass graft patency with a sensitivity of 92.8% and specificity of 83.3%; this technique has significant clinical limitations because resolution is not adequate to evaluate the presence of graft stenosis.