[Hematoma of right ventricular outflow tract mimicking an infiltrating tumor as a consequence of acute aortic dissection]. / Dissecazione aortica acuta complicata da ematoma del tratto di efflusso ventricolare destro.

The aortic dissection may be associated with unusual complications such as fistula formation and vascular compression. We describe a case of a 71-year-old patient admitted to our Hospital because of acute chest pain; transthoracic and transesophageal echocardiography revealed the presence of a type A aortic dissection associated with a mass infiltrating the right ventricular outflow and proximal tract of the pulmonary artery. The ultrasonographic morphology and the surgical findings showed the presence of a hematoma which was consequent to acute aortic dissection and which mimicked a tumor infiltrating the right ventricular outflow.

Hemodynamic performance of the Edwards Prima stentless valve.

BACKGROUND AND AIM OF THE STUDY: Stentless porcine valves are considered to have a superior hemodynamic performance when compared with stented bioprostheses. In the present study we report our initial experience with the Edwards Prima stentless valve (EPSV), focusing on the hemodynamic performance of this device evaluated by means of transthoracic two-dimensional (2D) Doppler echocardiography. METHODS: Between December 1994 and August 1995, 23 patients underwent aortic valve replacement with the EPSV implanted in the subcoronary position. Evaluation of hemodynamic performance of the EPSV was assessed before discharge (one week) and at six months follow up by means of transthoracic 2D echocardiography. RESULTS: There were no operative deaths and no major postoperative complications. Hemodynamic data were available for comparison at one week and six months in 18 patients (23 mm, n = 8; 25 mm, n = 10). For 23 mm EPSV, peak gradient varied from 42.7 +/- 10.2 mmHg at one week to 29.7 +/- 9.8 mmHg at six months (p = 0.01); for 25 mm EPSV, peak gradient varied from 33.6 +/- 10.6 mmHg at one week to 29.5 +/- 6.5 mmHg at six months (p = N.S.). CONCLUSIONS: The EPSV, when used in the subcoronary position, has been associated with high early transprosthetic gradients which only partly regress at six months. Gradients are probably caused by the inward folding of the Dacron cloth beneath the right coronary ostium and were recorded especially in patients with aortic stenosis in whom the right coronary ostium was close to the aortic annulus. In such patients alternative implantation techniques should be considered.

[Role of transesophageal echocardiography in mitral valve repair]. / Ruolo dell'ecocardiografia transesofagea nella ricostruzione valvolare mitralica.

This study was designed to prove the utility of intraoperative echocardiography in the mitral valve repair, that offers many advantages over valve replacement. We have assessed 21 consecutive patients, 12 with mitral incompetence and 9 with mitral stenosis, undergoing mitral valve surgery over a period of 6 months. Preoperative transthoracic and intraoperative transesophageal or epicardial echocardiography were performed in all patients. We have assessed, before and after repair, the valve morphology, the presence and the severity of mitral regurgitation, the pulmonary venous flow, the presence of left ventricular outflow tract obstruction. The intraoperative echocardiographic examination revealed a successful mitral repair in all patients except one in whom, for the persistence of severe mitral regurgitation after repair, valve replacement was performed. In none patient systolic anterior motion of mitral apparatus was observed. Intraoperative echocardiography seems to be a useful technique to assess the adequacy of mitral valve repair before chest closure and, in the case of failure, the need for further surgery (valve reconstruction or replacement).