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L'ischemia miocardica silente da sforzo è un fattore prognostico migliore dell'ischemia silente accertata durante la vita quotidiana
No full text
[Anomalous origin of the right coronary artery from the pulmonary artery: a case report].
No full textThe abnormal origin of the right coronary artery from the pulmonary trunk is currently one of the most significant coronary anomalies that is not associated with diffuse atherosclerotic involvement. Because of the lack of specific symptoms, it is often the outcome of casual observation during heart surgery or autopsy. At times, the patients die of congestive heart failure or sudden death without even having had this anomaly diagnosed. We describe the case of a 41-year-old woman who came under our observation due to palpitations, both at rest and under stress, that were also associated with chest pain at times. Clinical and instrumental investigation revealed the abnormal origin of the right coronary artery from the pulmonary trunk, indicating that the symptoms were probably caused by intracoronary or intercoronary "stealing". The primary treatment of this pathology is based on surgical techniques, and it is constituted by the simple ligation of the anomalous vessel or the ligation of the right coronary artery, with saphenous vein by-pass grafting or the reimplantation of the right coronary artery into the aorta. We opted for reimplantation of the anomalous vessel into the aorta: a three-year follow-up has shown very good results, with complete disappearance of the symptoms
Attuali limiti e possibilità dell'informatica nella valutazione "digital" delle coronarografie
No full textClinical significance of small left-to-right shunts after percutaneous mitral valvuloplasty
No full textAbstract
Left-to-right shunt after percutaneous mitral valvuloplasty was evaluated by contrast echocardiography in 29 patients at 24 hours and at 1, 3, 6, and 9 months after the procedure. The patients were divided into two groups: in group A (13 patients) the double-balloon technique was used; in group B (16 patients) the Inoue single-balloon technique was used. The two groups were comparable in terms of age, gender, and mitral valve area before and after percutaneous mitral valvuloplasty. A left-to-right shunt was detected in all patients 24 hours after the procedure. At 1 month follow-up the shunt was present in 12 patients of group A (92%) and in 13 of group B (81%) with a statistically significant difference (p < 0.001). At 3 months the values were 7 (54%) in group A and 6 (37.5%) in group B (p < 0.05); at 6 months the values were 3 (23%) in group A and 3 (19%) in group B (NS). At 9 months a left-to-right shunt was no longer detectable in any of the patients in either group. The disappearance of the shunt could be related to a healing process of the atrial septal injury that occurs within a few months after percutaneous mitral valvuloplasty. This process seems to be more rapid in group B patients, probably because of the smaller lesion that is produced in the atrial septum by the passage of the Inoue balloon
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