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Postinfarction ventricular septal defect (PIVSD) is challenging in both diagnosis and management. Especially in case of percutaneous treatment, a comprehensive echocardiographic assessment is needed. Bidimensional echocardiography enables localization and quantifi cation of intracardiac shunting aiding occluder devices proper choosing and positioning. Nevertheless real time three‐dimensional (3D) echocardiography usage presents additional benefi ts, defi ning in details the site of rupture and the surrounding cardiac structures. By 3D transesophageal guidance, delivery maneuvers are optimized and inappropriate expansion or position of the implanted device can be accurately assessed. In conclusion, real time 3D echocardiography emerges as a valid and advanced tool in diagnosis and management of PIVSD.

Objectives:The aim of this study was to evaluate the hemodynamic performance of a sutureless bioprosthesis under high workload at mid-term follow-up. Methods:Thirty-two patients who underwent isolated aortic valve replacement with a Perceval sutureless bioprosthesis with a minimum follow-up of 1 year were enrolled in this study. S size prosthesis was deployed in 10 patients (31.3%), M size in 9 (28.1%), L size in 8 (25%) and XL size in 5 (15.6%). Effective orifice area (EOA), EOA index (EOAi), and transvalvular gradients were assessed at rest and during dobutamine stress echocardiography (DSE) a median of 19.5 months after surgery.Results: Dobutamine stress echocardiography (DSE) significantly increased heart rate, stroke volume, ejection fraction, and transvalvular gradients (peak gradient, 24.0 ± 7.6 vs 38.7 ± 13.6 mm Hg, P < .001; mean gradient, 12.6 ± 4.2 vs 19.8 ± 8.3, P < .001).When compared to baseline, estimated valve areas significantly increased at follow-up (EOA, 1.48 ± 0.46 vs 2.06 ± 0.67, P < .001; EOAi, 0.84 ± 0.26 vs 1.17 ± 0.37, P < .001).Mean percentage increase in EOAi was 40.3% ± 28.0%. S size prostheses had the highest increase in EOA1, but the difference was not significant (S 46.0% ± 27.5% vs M 45.4% ± 34.5% vs L 32.7% ± 26.4% vs XL 32.1% ± 20.5%, P = .66). Severe patientprosthesis mismatch (EOAi ≤ 0.65 cm 2 /m 2 ) was present at rest in 8 patients (25%), but only in one patient (3.1%) during DSE. Conclusions:The Perceval sutureless bioprosthesis demonstrated good hemodynamics at rest and under high workload. The significant increase in EOAi during DSE suggests the potential advantages of Perceval sutureless bioprostheses in case of small aortic annulus or when patient-prosthesis mismatch is anticipated. K E Y W O R D Saortic valve prosthesis, aortic valve replacement, dobutamine stress echocardiography, sutureless

Atrial septal aneurysm when associated to other cardiac abnormalities, such as patent foramen ovale, Chiari network or Eustachian Membrane, is a well-known recognised risk factor for cerebral embolism. Aim of study is to assess if isolated atrial septal aneurysm could be considered statistically related to cryptogenic stroke, considering the strong clinical impact that this association could have on these patients outcome. 579 patients were investigated for a suspected patent foramen ovale using transthoracic echocardiography, in order to evaluate the presence of atrial septal aneurysm and to identify other potential cardiac embolic sources. The patients with atrial septal aneurysm underwent transcranic echodoppler and transoesophageal echocardiography examination with contrast solution during Valsalva manoeuvre.209/579 (36%) patients where we made diagnosis of atrial septal aneurysm. In this cohort of patients transcranic echodoppler showed a patent foramen ovale in 114/209 (54%), whereas transoesophageal echocardiography in 111/209 (53%); 6/114 (5%) patients with a positive transcranic echodoppler had a normal transoesophageal echocardiography examination and 3/95 (3%) with normal transcranic echodoppler had a positive transoesophageal echocardiography. Transcranic echodoppler vs. transoesophageal echocardiography sensibility was 97% and specificity 94%. Only 13/98 (13%) of patients with isolated atrial septal aneurysm and 23/111 (26%) with patent foramen ovale had history of cryptogenic stroke. According to our data, isolated atrial septal aneurysm could not be considered an independent risk factor for cryptogenic stroke.

Chronic total coronary occlusions (CTO) are found in approximately 15-30% of patients who undergo coronary angiography for suspected or known coronary artery disease. Speckle Tracking Echocardiography (STE) is a novel technology to assessing modifications of myocardial deformation with higher accuracy than the simple visual of regional wall motion. Purpose: The study was to evaluate, using STE applied to dobutamine stress echocardiography (DSE), changes in echo parameters before and after successful recanalization of a CTO. Methods: Eleven patients with subacute or chronic coronary syndromes and angiographic evidence of CTO, scheduled for reopening by percutaneous coronary angioplasty, underwent DSE, using standard protocol, before and 3 months after CTO recanalization. The acquisition of Echo images was performed at baseline and peak stress. Left ventricular ejection fraction (EF), volumes, wall motion score index, parameters of diastolic flow, tissue velocities at mitral annulus, global longitudinal strain (GLS), strain rate (SR), systolic and diastolic longitudinal functional reserve (SLR and DLR respectively) were obtained at baseline and at peak stress before and after percutaneous coronary angioplasty (PCI). Results: The mean follow-up after PCI was 3.09 ± 1 months. Statistical analysis showed significant improvement after PCI in EF, comparing to baseline (P < 0.03) and stress peak (P < 0.001) in systolic SR from the 4 chamber-view (P < 0.02), in DLR (P < 0.01), but there were no significant changes for SLR, GLS and SR. Conclusion: Stress echocardiography associated with new imaging techniques, such as STE provides further improvements of diagnostic accuracy in CTO patients.

Colonic varices are a rare condition primarily caused by portal hypertension associated with conditions such as cirrhosis or hepatocellular carcinoma. Idiopathic cases are even rarer, with less than 50 cases with a pancolonic affection reported in the literature. Males are more commonly affected, with an average age of 41 years. Colonic varices can involve the entire colon in idiopathic cases and are often familial. Gastrointestinal bleeding is the main symptom, ranging from mild to life-threatening. Diagnosis is typically made through colonoscopy, which reveals dilated bluish vascular tracts. Treatment involves fluid IV resuscitation and controlling hemorrhage through various methods such as endoscopic procedures. Correction of the underlying cause is essential in cases of portal hypertension. Recurrent or unstable cases may require colon resection.On this occasion, we present the case of a female patient who experienced profuse lower gastrointestinal bleeding. The patient's colonoscopy revealed the presence of varices throughout the entire length of the colon, with the only recent bleeding site being in the hemorrhoidal tissue. Therefore, a hemorrhoidectomy was performed to carry out an effective and less invasive therapeutic procedure than a colectomy with an excellent postoperative evolution.

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In its language policy and planning (LPP), Colombia offers ethnoeducation for ethnic groups, with Spanish as a second language, and for the protection/revitalization of native languages. However, these LPP measures are insufficiently implemented. Meanwhile, with regard to foreign languages, LPP have specifically advocated a Spanish-English bilingualism emphasized since the early 2000s. What then favours English to the detriment of native languages? The objective of this research is to reveal what is hidden behind this LPP through a Critical Discourse Analysis of official documents. The elements brought to light show unilingualism and unibilingualism ideologies that discriminate against native languages, and value the linguistic imperialism of English.