[Clinical evaluation of the therapeutic effect of D-L-carnitine in the acute phase of myocardial infarct in relation to the behavior of the serum myoglobin concentration curve]. / Valutazione clinica dell'effetto terapeutico della D-L-carnitina nella fase acuta dell'infarto del miocardio in riferimento al comportamento della curva di concentrazione serica della mioglobina.

Clinical experience carried out on 40 patients with AMI - 22 of them treated with 15 g daily of D-L-Carnitine and 18 untreated - is reported. Our interest was to study the therapeutic action of this drug evaluating if it was able to modify the curve of serum myoglobin level released from necrotic or ischaemic areas. The conclusion is drawn that this drug could act feebly only during the earlier stages of AMI, but many reserves are expressed.

[Paradoxical movement of the interventricular septum and LAE in a case of complex congenital cardiopathy in an adult with predominant overloading of the right ventricle pressure]. / Movimento paradosso del setto interventricolare ed EAS in un caso di cardiopatia congenita complessa dell'adulto a prevalente sovraccarico di pressione del ventricolo destro.

A casually observed case of complex congenital cardiopathy in an adult marked by ECG LAE, and paradoxical movement of the interventricular septum when examined echocardiographically is reported. Haemodynamic investigation established the persistence of a left vena cava superiore draining into the coronary sinus, pulmonary stenosis with a 55 mmHg transvalvular gradient, and a small PDA with left-to-right shunt equal to 20% of the pulmonary capacity. The case is presented on account of the infrequent association of these defects, the unusual ECG LAE, and above all on account of the echocardiographic picture of paradoxical movement of the IVS in the presence of right ventricle overloading.

[Occult pre-excitation. Differential diagnosis between latent Wolf-Parkinson-White syndrome and concealed atrial pre-excitation (endocavitary electrophysiological study)]. / La preeccitazione occulta. Diagnosi differenziale tra sindrome di W.P.W. latente e preeccitazione atriale nascosta (studio elettrofisiologico endocavitario).

Sixty patients (pts) with very disabling symptoms during supraventricular tachycardia (SVT) underwent electrophysiological study to determinate the mechanism of arrhythmia. 20 pts had, during normal sinus rythm (NSR), ECG pattern of ventricular pre-excitation (V-P); 40 pts, instead, had ECG pattern within normal limits (WNL). In V-P pts, circus movement tachycardia by overt accessory pathway (AP) was initiated. Among ECG-WNL pts group: 10 pts showed ectopic atrial rythm; 22 pts had SVT due to A-V nodal reciprocation; and 8 pts revealed the participation of concealed AP in the reentrant circuit of tachycardia. Among these latter, atrial stimulation at various sites and drugs-administration discovered extranodal by-pass liable for concealed V-P in 2 pts; in the remaining 4 pts it was possible to demonstrate concealed atrial preexcitation by ventricular stimulation, during NSR and SVT, and by atrial mapping during ventricular stimulation and SVT. Our report confirms the significative incidence of concealed AP at the basis of numerous cases of SVT (26%) and outlines the distinction between the latent W.P.W. syndrome and the atrial preexcitation, due to anomalous by-pass with anterograde block.

Hemodynamic changes induced by supraventricular tachycardia.

In nine patients (pts.) with recurrent SVT, we have performed a combined electrophysiological and hemodynamic study. Five pts. showed reciprocating nodal tachycardia and 4 pts. reentry tachycardia associated with WPW syndrome (2 with Kent bypass tract and 2 with James bypass tract). Hemodynamic parameters were recorded during sinus rhythm (SR), atrial (AP) and ventricular pacing (VP) and following the initiation of SVT. The arrhythmia was induced by rapid atrial pacing or with atrial or ventricular premature stimuli. Hemodynamic data were then compared. Our results point out a greater hemodynamic deterioration during SVT than during AP or sinus tachycardia at similar rates. We have often observed in SVT, and constantly in A-V nodal reentrant (AVN) cases, the appearance of giant waves in the right and left atrium. This finding confirms hypothesis of the primary role of the changes in atrioventricular contraction sequence during SVT, especially in AVN tachycardias, with subsequent reduction in stroke volume and cardiac output.

[Therapy with beta-blockers in the patients with mitral valve stenosis. Clinical and hemodynamic study]. / Terapia con betabloccanti nei malati affetti da stenosi mitralica. Studio clinico ed emodinamico.

Five patients with pure mitral stenosis and atrial fibrillation were studied with cardiac catheterization in the usual fashion before and after administration of 2.5 mg. of propranolol. At the end the selective left ventricular angiocardiography was performed. The following parameters were calculated: heart rate, mean pulmonary wedge pressure, left ventricular end-diastolic pressure, cardiac output, end-diastolic pressure gradient through the mitral valve. Other five patients with slight mitral stenosis and sinus rhythm were treated with propranolol (40-100 mg for day) for a period of one month. Before beginning the treatment and when it was stopped the following parameters were calculated: pulmonary wedge pressure, cardiac output (Fick), heart rate. After all ten patients were treated with propranolol for a period of 6-12 months. The haemodynamic , clinical and angiographic features are analysed and discussed. The Authors conclude asserting the utility of this drug when administered to patients with slight mitral stenosis (I or II NYHA) for its favourable effect to reduce the pulmonary wedge pressure and pulmonary congestion.

[Modern methods of evaluation of sinus node function by means of endocardiac electrophysiological study]. / Moderne tecniche di valutazione della funzione del nodo del seno mediante studio elettrofisiologico endocardico.

Atropine sulfate 0.04 mg/Kg i.v. and propranolol 0.2 mg/Kg i.v. were administered to patients with SSS in an attempt to determine intrinsic heart rate (IHR). Sinus node recovery time (SNRT) was determined before and after autonomic sympathetic and parasympathetic blockade. This method could distinguish SSS patients in two groups: group I was composed of patients with extrinsic sinus node dysfunction, group II was composed of patients with intrinsic sinus node dysfunction. We conclude that this differentiation is of great importance for clinical-prognostic evaluation and therapeutic program in SSS.