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A prospective study has been conducted, in patients with dilated myocardial disease, in order to examine the relation between echocardiographic variables and mortality rate. Patients were divided into two major groups: (1) group A—designed to evaluate the influence of the ventricular filling pattern in the mortality rate. It included 95 patients, followed‐up for a period ranging from 1–23 months (mean = 12.6 months), divided into three subgroups: AF (atrial filling predominant pattern, n = 22); N (normal or “normalized” filling pattern, n = 40), and RF (rapid filling predominant pattern, n = 33); and (2) group B—designed to correlate echocardiographic variables to the 1‐year mortality rate. It included 52 patients divided into two subgroups: survivors (n = 40) and nonsurvivors (n = 12). In group A, a progressive decrease in survival rate was noted on comparing subgroups N to AF to RF. At the 14 months follow‐up a survival rate of 89% was noted in N, 75% in AF, and 50% in RF. Univariate analysis in group B showed high 1‐year mortality rate associated with mitral flow deceleration time ≤ 140 msec (50%, P = 0.003), left ventricular diastolic diameter/thickness ratio ≥ 3.4 (35.3%, P = 0.002), and left atrial index ≥ 25 mm/m2 (40.7%, P = 0.001). The highest mortality rate (61.5%, P = 0.0004) was observed in patients with increased left atrial index and decreased deceleration time. Thus, diastolic dysfunction and anatomical changes, as evaluated by echocardiography, are confident parameters to estimate the prognosis in dilated myocardial disease.

Double outlet right ventricle (DORV) is a heterogeneous group of abnormal ventriculoarterial connections where, by definition, both great arteries (pulmonary artery and aorta) arise primarily from the morphologically right ventricle. This condition affects 1-1.5% of the patients with congenital heart diseases, with a frequency of 1 in each 10,000 live births. We report the case of an 18-day-old infant with DORV and extremely rare anatomical features, such as anterior and left-sided aorta and subpulmonary ventricular septal defect (VSD). In addition to the anatomic features, the role of the echocardiogram for guiding the diagnosis and the surgical therapy of this congenital heart disease are discussed.

In healthy individuals, maximum left ventricle segment velocities decreased from the bases to the ventricular apex, with certain proportionality between contraction and relaxation (P<0.05). The use of Doppler tissue imaging may be very helpful in detecting early alterations in ventricular contraction and relaxation.

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Different vascular abnormalities have been reported under the denomination of "persistence of the fifth aortic arch." Detailed studies on experimental embryology raised the discussion about the existence of the fifth aortic arch as an embryological structure, both in humans and mammals. In 1969 the Van Praaghs described the occurrence of double left aortic arch, denominating such anomaly as persistence of the fifth arch. We describe here a female patient showing the presence of an anomalous vessel in parallel with the aortic arch. The finding was occasional, during a preoperative evaluation for cholecystectomy.

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Heart failure is one of the major causes of mortality, morbidity, and hospitalization in patients older than 60 years, accounting for 1 to 2% of the total expenditure in the health sector in the United States (approximately 20 billion dollars per year!) 1,2 . Despite the great advances in therapy, the morbidity and mortality rates still remain high 3 . Cardiac resynchronization therapy (CRT) was introduced in the beginning of the 1990's and rapidly developed until its approval in 2001 by the FDA (Food and Drugs Administration) 4 .In the American Heart Association guidelines, CRT has been considered to be IIA evidence level 5 . Those guidelines were based on 2 large trials: the MUSTIC 6 and the MIRACLE 7 . In both, the inclusion criteria were similar: a) significant heart failure despite appropriate therapy; b) low ejection fraction; and c) broad QRS with left bundle-branch block pattern (duration>120 ms). Both studies have confirmed that CRT significantly improves symptoms, tolerance to exercise, and quality of life. Nevertheless, 20% to 30% of the patients do not improve with CRT 8 , emphasizing the need for new criteria of patients' selection.Recent studies have reported that mechanical dyssynchrony is not always related to electrical dyssynchrony 9,10 , and that the presence of ventricular dyssynchrony is the best predictor of a good response to resynchronization therapy. In reality, some patients with broad QRS may not have mechanical dyssynchrony while others with narrow QRS may [11][12][13] .Although QRS duration is a good prognostic marker for mortality in patients with heart failure and is present in more than 80% of the individuals in the 2 months preceding death 14,15 , studies comparing QRS alterations with the clinical outcome of patients seem to show little or no relation to prognosis 16 .These data suggest that electrocardiography may not be the best complementary diagnostic method for selecting candidates to CRT. Other imaging techniques, particularly the new methods for assessing ventricular function on echocardiography, seem to be better for selecting patients who will best respond to resynchronization therapy.Both the presence of broad QRS and the signs of interventricular dyssynchrony are predictors of hospitalization and severe cardiac events in patients with heart failure 17,18 . Ventricular dyssynchronyThe mechanism of dyssynchrony includes regional delays of both ventricular contraction and relaxation. The right ventricle contracts during left ventricular telediastole leading to a septal bulging towards the left ventricle. In addition, the delay in the activation of the papillary muscles causes, or worsens, mitral incompetence 19 . All such factors contribute to a reduction in the ejection fraction and a worsening of the clinical symptoms.Dyssynchrony may be inter-or intraventricular, and echocardiography may evaluate both types through several techniques.One way of evaluating interventricular dyssynchrony is by measuring the time between ventricular ejections. Conventional Doppler measure...