[The accidental diagnosis of a left atrial myxoma in an 80-year-old female]. / Diagnosi accidentale di mixoma atriale sinistro in ottuagenaria.

Left atrial myxoma is usually diagnosed in patients between the ages of 30 and 60 and this diagnosis follows non-specific symptoms (i.e. temperature, anemia, weakness), and obstructive or embolic episodes. There are few cases in the literature of this disease in patients older than 80. We report the case of an 80-year-old female admitted to our institute for an episode of supraventricular tachycardia. After successful treatment of the arrhythmia using verapamil i.v., a routine echocardiographic examination showed the presence of a left atrial mass, and its appearance suggested the diagnosis of a left atrial myxoma. A CT scan and a transesophageal echocardiography confirmed the diagnosis. The patient subsequently underwent cardiac catheterization and coronary angiography. In the absence of significant lesions of the coronary artery, a decision was made to remove the myxoma surgically, based on two considerations: the good clinical status of the patient and the high current risk of peripheral embolization. The operation was successful in removing the myxoma and the patient continues to be in good clinical condition.

Intrapatient comparison between chronic VVIR and DDD pacing in patients affected by high degree AV block without heart failure.

In patients affected by high degree AV block without preexisting congestive heart failure there is no definite demonstration that DDD pacing gives real clinical advantages in respect to VVIR pacing. We performed an intrapatient, long-term study between the two pacing modes in 14 high degree AV block patients, using the Medtronic Synergyst 7027 dual chamber pacemaker, who could be programmed alternatively in DDD or VVIR mode. After a 4-week run-in period following the pacemaker implant, patients completed a randomized, double-blind, cross-over study to compare the effect of 6-week period VVIR and DDD pacing on symptoms and cardiovascular parameters. A semiquantitative score scale was used to quantify the symptoms of general well-being, palpitations, dizziness, pulsating sensation in the neck or abdomen, shortness of breath at rest and during effort, chest pain, and NYHA classification. The sum of symptom scores was 10.4 +/- 6.7 in VVIR period and 4.6 +/- 2.7 in DDD period (P less than 0.001); five patients (36%) crossed over early from VVIR to DDD because of intolerable symptoms; overall, eight patients preferred the DDD mode and no one preferred the VVIR. Cardiac output at rest (echo-Doppler method) was 4.7 +/- 1.4 versus 5.7 +/- 1.6 liter/min (P less than 0.01), body weight was 65.9 +/- 6.6 versus 64.9 +/- 6.1 kg (P less than 0.02), atrial natriuretic peptide was 236 +/- 112 versus 198 +/- 110 pg/mL (P less than 0.01), respectively, during VVIR and DDD modes. Effort tolerance was similar with the two modes of pacing (68 +/- 15 vs 70 +/- 18 watts/min).(ABSTRACT TRUNCATED AT 250 WORDS)