We describe the case of a 50-year-old woman who was admitted to a pheriferal department for heart failure. The echocardiography revealed a small mass measuring about 1.3 × 1.0 cm adhering to the non-coronary cusp of the aortic valve, mild dilated cardiomiopathy and severe biventricular dysfunction. This mass had erroneously been considered a thrombotic lesion, so the patient was treated with thrombolysis and heparin e.v. Only after a transoesophageal echocardiography a tumour cardiac mass was suspected. The diagnosis of fibroelastoma was confirmed by MRI and then from the anatomic and histoligical definition after surgery.

Arsenic trioxide is an effective treatment for patients with acute promyelocytic leukaemia (APL) who have relapsed from or are refractory to all trans-retinoic acid and anthracycline chemotherapy. Cardiac effects observed include electrocardiographic changes such as QTc prolongation, T-wave abnormalities, torsades de pointes and sudden death. We describe a case of a man, 76 years old, who was admitted to our department for dyspnoea in APL in treatment with arsenic trioxide. Chest radiograph illustrated an enlarged cardiac silhouette and bilateral pleuric effusion and the ECG evidenced QT prolongation. The patient was also submitted to transthoracic echocardiography that revealed moderate pericardial effusion without signs of cardiac tamponade and a normal biventricular function. This condition was considered to be associated with arsenic trioxide polyserosit and the drug therapy was immediately discontinued and steroid drugs started. After 2 weeks of arsenic trioxide therapy suspension there was evidence of complete resolution of pericardial and pleuric effusion and the ECG showed normal QT interval.

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PresentationDr. Vizzardi: We describe the case of a man, 55 years old, who was admitted to our Intensive Coronary Unit for severe chest pain. The past history included smoking and hypertension, while there was a family history of coronary artery disease.At the time of admission the blood pressure was 120/ 60 mmHg and the heart rate was 78 beats per minute. The electrocardiogram showed ST segment elevation in the anterior leads, and a transthoracic echocardiogram (TTE) revealed anterior septal and anterior wall akinesis with a severe systolic dysfunction (ejection fraction of 30%).After treatment with aspirin, beta-blockers, nitrates and heparin plus a bolus and continuous infusion of abciximab, the patient underwent coronary angiography showing total occlusion of the left anterior coronary artery. A successful angioplasty was performed. In order to reduce the risk of acute thrombotic reocclusion of the culprit artery, abciximab infusion was continued. After 6 h, the patient developed severe dyspnea and tachypnea. The pulse oximetry revealed a severe oxygen desaturation of 88% with 100% FiO 2 , Laboratory tests showed severe thrombocytopenia (platelets 5,000 mm 3 ) and a significant drop in hemoglobin levels (3.1 g/dl). A Chest radiograph revealed new bilateral diffuse lung opacities infiltrates (Fig. 1).The anticoagulation therapy was stopped immediately, and the patient was transfused with platelets and packed red blood cells. We observed a rapid improvement in the platelet count and hemoglobin values (respectively of 145,000/mm 3 and 13 g/dl). The erythrocyte sedimentation rate and others autoimmune serology tests were negative. The Chest X-ray studies showed a progressive and complete resolution of the alveolar infiltrates; therefore after ten days clopidogrel (75 mg/die) and aspirin (100 mg/die) were restarted.Before discharge, a TTE revealed only moderate left ventricular systolic dysfunction (EF 45%). Preliminar diagnosisDr. D'Aloia, Dr. Zanini, Dr. Antonioli: The use of abciximab, a chimeric monoclonal antibody Fab fragment specific for platelet glycoprotein IIb/IIIa receptors, in patients presenting with acute ischemic coronary syndromes, is associated with improved outcome after percutaneous coronary angioplasty (PTCA) and stent placement [1-4] but complications include major hemorrhage with anaemia and thrombocytopenia [2][3][4][5].Bleeding can occur in the presence or absence of thrombocytopenia varying from mild to severe, and usually occurring within 24 h after initial exposure to the drug [5]. Pulmonary alveolar haemorrhage (PAH) is a serious but rare life-threatening complication [6][7][8][9][10][11].

We describe a case of a man, 42 years old, submitted to successful fibrinolitic strategy with rTPA in acute mitralic prosthesis valve thrombosis and ipomobility of one emidisk. There aren't a consensus agreement in therapeutic strategy but we may support the approach of some authors that employ fibrinolisis in patients without absolute or relative controindications and if thrombus dimension is less than 1 cm otherwise they make use of heparin therapy in non obstructive thrombosis with successive transesophageal echocardiography evaluation for the efficacy and the later indication for thrombolisis or surgery treatment.