Replacement of a prosthetic valve after the Bentall procedure.

Patients undergoing a composite graft replacement of the aortic root with reimplantation of the coronary ostia (Bentall procedure) are at risk for late prosthetic heart valve dysfunction: approximately 10% of the patients are expected to experience this complication at 10 years. Therefore, replacement of the prosthetic valve is indicated. This procedure involves technical problems related to the manipulation and the reconstruction of the composite graft without distortion of the coronary arteries. We describe a simple surgical approach to treat these particular patients.

Percutaneous embolization of an isolated hypogastric artery aneurysm. A case report.

We describe a case of an isolated aneurysm of the left hypogastric artery which came under our observation because of a syndrome of compression on the homolateral iliac vein. Having excluded the presence of aneurysms in other sites, it was decided to perform a percutaneous embolization of the hypogastric aneurysm. The follow-up revealed the disappearance of the compression on the ipsilateral iliac vein and a 30% reduction in the diameter of the thrombosed aneurysm. The method limited invasiveness, the reduction in volume of the aneurysmal mass, the disappearance of compression problems, and the shortened hospitalization time support the choice of embolization treatment.

[Hepatocellular carcinoma (HCC): the long-term response to tamoxifen. A clinical case report and review of the literature]. / Carcinoma epatocellulare (HCC): risposta prolungata al tamoxifen. Descrizione di un caso clinico e revisione della letteratura.

A 52 years old female with hepatocellular carcinoma (HCC) was treated successfully with Tamoxifen. The tumor involved IV hepatic segment with hilar extension and biliary obstruction, was unresectable, and had been pretreated with hormone-chemotherapy. Tamoxifen treatment induced a PR of 6 months, with normalization of serum bilirubin, reduction of alfa-fetoprotein level and improvement of PS, and was free of toxicity. At disease progression intra-arterial chemotherapy with Cis platinum (CDDP) and 5-FU gave a further 4 months PR, until disease progression and exitus in hepatic coma. Tamoxifen therapy, even in the absence of E.R. assay is a useful tool in the management of HCC patients. Further randomized studies are necessary to ascertain the role of Tamoxifen in the treatment of HCC.

Carotid artery dissection. Correlation of different diagnostic techniques.

Dissection of the carotid artery is a rare entity, but a frequent cause of cerebrovascular accidents in young adults and can result in severe neurologic consequences that are often irreversible. Carotid dissection can be secondary to trauma, brisk rotation of hyperextension of the neck, as a complication in certain diseases. It may lead to distal embolization, complete occlusion of the vessel, extensive or limited stenosis, aneurysmal form which has the appearance of a berry aneurysm or resolution of the process with complete patency of the dissected vessel. The authors find color-Doppler sonography to be an invaluable tool in the evaluation of such a process, since it is non invasive, readily available, relatively inexpensive and can yield detailed information about the lumen of the vessel, blood flow, mural and intramural structures. Furthermore, in comparison to MRA, color-Doppler sonography is particularly suitable for the early detection of thrombus. Ultrasonographic investigation has some methodologic limitations: occlusion cannot always be demonstrated directly because of its high cervical location and detection of aneurysms localized in the retrostyloid++ space is usually not possible. The combination of ultrasonographic findings and MRA is the method of choice for follow-up on evaluation of carotid dissection and helps make the decision as to whether one should proceed to angiography in this young age group.

Five-centimeter superior mesenteric artery aneurysm. A case report.

An unusual large mesenteric artery aneurysm presented as "angina abdominis" and abdominal mass is described. Endoaneurismectomy with reverse end-to-end saphenous vein graft was performed. The incidence, pathogenesis and diagnosis are reviewed and the treatment is discussed.

[Coarctation of he abdominal aorta]. / Coarctation of the abdominal aorta.

The Authors report a 49-year-old woman complaining of slight nocturnal lower limb pain in whom an uncommon type IV coarctation of the infrarenal aorta associated with multiple renal arteries, slight hypoplasia of iliac and femoral arteries bilaterally, and a retroaortic left vein were found. She underwent an aorto-aortic prosthetic repair. The correction of this vascular condition was followed by partial improvement of her symptoms. The suspicion of an associated ischaemic spinal origin of these painful symptoms may be suggested by the typical and often complex presence of multiple vascular malformations described in patients with coarctation of the abdominal aorta.

[Aneurysm of ascending aorta associated with aortic valve incompetence. Surgical correction by replacement of right coronary artery in 15 patients (author's transl)]. / L'aneurisma dell'aorta ascendente associata ad insufficienza valvolare. Correzione chirurgica radicale con reimpianto delle coronarie in 15 pazienti.

15 patients with aneurysm of ascending aorta associated with aortic valve incompetence has been treated by the replacement of the aortic valve and ascending aorta with reimplantation of the right coronary artery in 8 patients and both coronary arteries in 7. The operative mortality was 13% (2 patients). The follow up interval ranged from 6 months to three years (mean 20 months) and in all 13 patients there was an improving of functional class. A post-operative angiography was performed in 6 patients and in all of them was demonstrated the patency of the neoostia, a minimum paravalvular leak in one patient, and a pseudoaneurysm in another one. Proving the necessity of complete replacement of aneurysmal aorta, the Authors discuss the technique adopted with particular reference to the problem of reimplantation of the coronary arteries.