[Sarcoidosis with predominant cardiac involvement]. / Sarcoidosi con prevalente interessamento cardiaco.

We present a case of predominantly myocardial sarcoidosis in a 38 year-old man. A second degree atrioventricular block was the clinical presentation, followed 2 years later by sudden cardiac arrest. Autopsy revealed large areas of myocardial scarring in the left ventricular wall unassociated with atherosclerotic coronary lesions; microscopy of these areas disclosed epithelioid granuloma with giant cells embedded in a fibrohyaline tissue. The insidious cardiac involvement in sarcoidosis often hinders an exact diagnosis in life, and prognosis without therapy is severe. Histopathologic diagnosis is made only by exclusion of other systemic granulomatous diseases.

Role of ageing, chronic renal failure and dialysis in the calcification of mitral annulus.

Mitral annulus calcification, a common lesion of the elderly (over age 60 years), has been detected with increased frequency and at younger ages in patients with uraemia. To date a pathogenic role for dialysis and secondary hyperparathyroidism has been suggested only on the basis of older dialytic age and increased serum iPTH observed in the affected individuals. Because this is a potentially dangerous lesion we deemed it useful to evaluate more completely the respective roles of possible pathogenetic factors in uraemic individuals. Evaluation included echocardiography, ECG, limb radiography, and serum assays. A total of 225 dialysis (HD) patients, 67 chronic renal failure (CRF) patients on conservative treatment and 67 normal subjects were studied. Mitral annulus calcification was detected in 87 of 225 (38.6%) HD patients, 11 of 67 (16.4%) CRF and six of 67 (8.9%) normals. In HD, patients with calcification were older and on longer-term renal replacement therapy compared to those without calcification. They also had greater values of iPTH, BGP, AP, and Rx score of secondary hyperparathyroidism. Mitral annulus calcification was associated more frequently (chi 2 = 14.8; P < 0.0001) with rhythm and cardiac conduction defects, but not with ectopic calcifications. Multiple stepwise regression analysis, with mitral annulus calcification score as dependent variable, selected dialysis duration, age, and iPTH (rm = 0.368) as the most predictive parameters, with the first two carrying most of the information. The stratification of patients according with these two parameters showed a progressive increase in the frequency of calcification both with HD duration and age.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation with Doppler echocardiography of the Bjork-Shiley Monostrut prosthesis in the mitral position]. / Valutazione mediante ecocardiografia Doppler della protesi Björk-Shiley Monostrut in posizione mitralica.

The Doppler characteristics of Björk-Shiley Monostrut prostheses in mitral position were studied in 53 patients (35 women; 18 men; mean age 53.8 yrs). Valvular function was considered normal on the basis of clinical and echocardiographic evaluation. Mean follow-up after surgery was 23.9 +/- 12.0 months (range 9-53). M-mode, two-dimensional and colour flow mapping echo were performed in each patient. Transvalvular blood flow characteristics were examined by colour flow imaging whereas peak and mean gradient through the valve, pressure half-time and prosthetic area were calculated using continuous wave Doppler. In 84% of patients, colour flow mapping showed a transprosthetic flow with 2 jets; in 78% the jets were different: the main one was directed towards the free wall of left ventricle in 52% and towards the interventricular septum in 48%. Thus, the main jet direction was dependent on the spatial position of the prostheses and the orientation of the disc. In 16% a single jet flow was present during the whole diastole. CW Doppler showed the following parameters: peak velocity 1.6 +/- 0.3 m/s; peak gradient 10.7 +/- 3.9 mmHg; mean gradient 3.8 +/- 2.3 mmHg; pressure half-time 83.3 +/- 16.6 msec; prosthetic area 2.7 +/- 0.51 cm2. No statistically significant difference was found between different size prostheses. Our data show the excellent long term hemodynamic parameters of Björk-Shiley Monostrut mitral prosthesis and confirm the value of colour flow mapping in identifying normal transprosthetic flow profile.

[Pulmonary atelectasis and massive pleural effusion. Echocardiography]. / Atelettasia polmonare e versamento pleurico massivo. Aspetti ecocardiografici.

Pulmonary atelectasis can be detected by Two Dimensional Echocardiography (2D-E) when massive pleural effusion is present. A triangular mass, base toward the mediastinum and apex moving freely in the pleural cavity, is shown by 2D-E either in an apical modified view in left pleural effusions or in a subcostal modified view in right pleural effusions. The texture of the mass is liver-like. Three cases are reported by way of example. Differential diagnosis with other masses, such as pleural or pericardial metastasis, is discussed.

[Usefulness of 2-dimensional echocardiography in emergency surgical treatment. Description of a case of metastatic sarcoma of the right ventricle]. / Utilità dell'ecocardiografia bidimensionale nel trattamento chirurgico d'urgenza. Descrizione di un caso con sarcoma metastatico del ventricolo destro.

A case of metastatic tumor, occupying a large part of right ventricular cavity, is reported. An accurate diagnosis was allowed by 2-D echocardiography and the patient was immediately sent to cardiac surgery. 2-D echo was also useful in the postoperative evaluation of surgical results.

Two-dimensional echocardiographic findings in a case of massive cardiac involvement by malignant lymphoma.

In a patient affected by malignant mediastinal lymphoma a severe congestive heart failure and the ECG pattern suggested a heart involvement. Two-dimensional echocardiography (2DE) documented the presence of abnormalities suggestive of infiltration: in particular, enormous thickening of the left ventricle, nearly absent wall motion, and "patchy" appearance of the myocardium were seen. Necropsy findings confirmed the presence of a massive lymphomatous infiltration of the heart. 2DE, by its ability to detect abnormalities consistent with heart infiltration, should provide a useful contribution in the staging of lymphomas.