Cardiologia (Rome, Italy)
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Cardiologia (Rome, Italy) · Dec 1994
Clinical Trial Controlled Clinical Trial[Role of transesophageal echocardiography in tricuspid valve repair].
This paper reviews the role of echocardiography in tricuspid valve repair by analyzing the results of three clinical studies. The first investigation was performed for assessing the outcome of two surgical techniques in two groups of patients who underwent De Vega's suture annuloplasty or Carpentier ring implantation. The patients were studied by color Doppler echocardiography after a mean follow-up of 28.7 +/- 11.1 months. ⋯ The results showed that tricuspid regurgitation occurs in most patients immediately after HTX; it is correlated to the ratio recipient-donor right atrium; surgical techniques which reduce the recipient atrium may decrease the occurrence and the degree of tricuspid regurgitation. The above mentioned clinical investigations showed a many-sided role of TEE in tricuspid valve repair. It provides not only a useful diagnostic tool for evaluating residual regurgitation, but it may actively guide the surgical procedures and contribute to improve the surgical technique.
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Cardiologia (Rome, Italy) · Aug 1994
Review Case Reports[An accelerated idioventricular rhythm and sports activity. Comments on a clinical case and a characterization of the arrhythmia].
In the evaluation of an accelerated idioventricular rhythm (AIVR) case presented by an athlete, even though considered qualified for agonistic sport practice in compliance with the COCIS protocol, the authors made some considerations relative to such type of arrhythmia. AIVR are characterized by a wide oscillation of frequency (from 40 to 120 b/min) and are distinguished as active AIVR when the ventricular center exceeds the discharge frequency in a non depressed sinusal activity; and it's passive AIVR when an automatic ventricular center substitutes the physiological pacemaker in the presence of sinusal bradycardia. This leads to think that it could be two different phenomenons. ⋯ Moreover, AIVR manifest a parasystolic type of behaviour that complicates the diagnostic differentiation. Therefore it can be considered that the arrhythmia of ventricular genesis (AIVR, ventricular tachycardia, parasystole) represents the varied expression of the same electrogenic substratum with different discharge potentiality. Thus was formulated the proposal of unifying the ventricular rhythms in one group which includes: rhythm of ventricular escapement, AIVR, parasystole and ventricular tachycardia.
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Cardiologia (Rome, Italy) · Aug 1994
Comparative Study[Multiplane transesophageal echocardiography for the monitoring of cardiac surgery].
Multiplane transesophageal echocardiography (TEE) allows visualization of the heart and great vessels through an infinite number of imaging planes and improves the diagnostic capabilities of mono and biplane TEE. This study was undertaken to test whether MTEE is a useful intraoperative monitoring method during cardiac surgery. Intraoperative multiplane TEE was performed in 200 patients (mean age 56 +/- 19 years) as a part of the routine clinical care. ⋯ All views analyzed in the preoperative (immediately before cardiopulmonary bypass), intraoperative and postoperative phases evaluating: the angle between current and 0 degree at which each view was obtained; the success rate of each view; the usefulness of the different views in providing essential additional clinical information compared to 0 degrees and 90 degrees of the traditional biplane TEE. Most views of the heart and great vessels were visualized in oblique planes, and other views were significantly improved thanks to slight angle corrections. Multiplane TEE was particularly useful in the preoperative and postoperative phases of aortic dissection (11 cases), mitral valve repair (13 cases), left ventricular aneurysmectomy (9 cases), right atrial thrombosis (1 case), positioning of left ventricular hemopump (2 cases), mitral-aortic endocarditis (3 cases), bleeding from proximal suture of an aortic heterograft (1 case).(ABSTRACT TRUNCATED AT 250 WORDS)
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Cardiologia (Rome, Italy) · Feb 1994
[Transesophageal echocardiography in the assessment of patients with atrial fibrillation and stroke].
Cardiac evaluation of stroke or transient ischemic attack (TIA) patients includes transthoracic and transesophageal echocardiography to identify potential cardiac source of embolism. In the present study transesophageal echocardiography was performed in 53 consecutive patients with non valvular atrial fibrillation and a previous embolic stroke. All patients were referred to our department because of an episode of atrial fibrillation. ⋯ The mitral valve analysis showed a leaflet prolapse in 3 patients. The entire thoracic aorta was imaged in each patient: in 12 an abnormal atherosclerotic plaque was found. Transesophageal echocardiography is an important component of the comprehensive evaluation of potential sources of embolism in patients with ischemic cerebral attack and nonrheumatic atrial fibrillation.
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Cardiologia (Rome, Italy) · Dec 1993
Review Comparative Study[Role of transesophageal echography in the study of embolism of cardiac origin].
In the total population, cerebrovascular ischemic diseases account for 0.2-0.3% cases per year, and in the 20-40% of them it is possible to recognize a cardioembolic mechanism. The cardiological examination in patients with stroke is, therefore, aimed at detecting cardiac sources of emboli (left atrial, valvular, and ventricular thrombosis, atherosclerotic plaques of ascending aorta), and at identifying the cardiovascular disease directly or indirectly associated with ischemic stroke. Transesophageal echocardiography (TEE) is particularly suitable for this purpose, due to the proximity of the transducer to the posterior cardiac structures and to its better resolution. ⋯ The role of TEE before and immediately after cardioversion in patients with atrial fibrillation has been recently studied by several papers. Cardioversion was proved at low risk of stroke when TEE did not show left atrial or left appendage thrombosis. Therefore, the transesophageal approach identifies patients needing prolonged anticoagulation (roughly 20%), avoiding an undue, potentially dangerous therapy.