Our study suggests that mitral annular systolic velocity <7.9 cm/s is associated to the onset of adverse cardiac events.

We report a female patient with asymptomatic cor triatriatum sinister, associated with 4q34.3 deletion. Her child, carrying the same imbalance, suffers from tetralogy of Fallot. To the best of our knowledge, this is the first reported case of cor triatriatum associated with deletion of the long arm of the chromosome 4; furthermore, the majority of patients with chromosome 4 long arm syndrome have de novo deletions and only few familial cases have been reported so far.

Submit Manuscript | http://medcraveonline.com (>99° percentile), height=110 cm, (BMI=41); the heart sounds were normal, a 2/6 Levine murmur was audible on the right sternal border; the breath sounds were diminished bilaterally, the peripheral oxygen saturation was 80%. The arterial blood gas analysis (ABG) revealed respiratory alkalosis (pH=7, 50), pO 2 =93 mmHg, pCO 2 =30mmHg. Endo-tracheal intubation and mechanical ventilation with 100% oxygen was necessary, furthermore a venous central catheter was placed into the right femoral vein. The chest X-ray study revealed bilateral infiltrates. Since a pneumonia was suspected the patient was treated with antibiotics (Teicoplanin and Ceftriaxone). Over six days, as the clinical conditions improved and the child was estubated, the venous central catheter was removed and she was transferred to the Pediatric Clinic. After one day the conditions suddenly worsened with dyspnea and signs of deep-vein thrombosis of the right limb, which was swollen and warm. Doppler ultrasound scan showed femoro-popliteal deep venous thrombosis. The echocardiography revealed a mildly dilatation of right ventricle and of inferior vena cava. Color -Doppler examination demonstrated a moderatesevere tricuspidal regurgitation, with a high atrio-ventricular peak pressure gradient (65 mmHg).D-dimer was sevenfold the upper limit. A second chest radiograph showed a mild left pleural effusion. Because P.E. was suspected the patient underwent a contrast enhanced computed tomography (CT) of the thorax that demonstrated clots into the upper and lower lobar right pulmonary arteries (Figure 1). The girl was treated with LMWH followed by warfarin with resolution of symptoms. Further laboratory tests for thrombophilia screening revealed methylene tetrahydrofolate reductase heterozygotes mutation with normal homocysteine plasma level and heterozygotes mutation of the Factor II (G20210A). The patient was discharged from hospital on oral anticoagulant therapy for six months and with a hypo-caloric diet.The second patient was a 10-years-old girl, affected by mental retardation and tetraplegia due to neonatal hypoxemia. Initially, he was admitted to nephrology department for anuria, elevated creatine (3mg/dL) and pedal swelling. Physical examination revealed a diaphoretic and tachypneic patient, with a heart rate of 140 beats/min, the pulse oxygen saturation in room air was 88% and failed to rise under supplemental oxygen (3 L/ min with nasal cannula), severe hypotension (systolic blood pressure <90mmHg), the heart sounds were normal while the breath sounds were diminished bilaterally, moreover jugular veins distension was noted. The ABG showed metabolic acidosis (pH = 7.2 and low bicarbonates =16 mmol/L), hypoxemia (pO 2 = 50 mmHg) and hypocapnia (pO 2 = 32 mmHg). Tachycardia and hypotension prompted an echocardiogram that showed dilatation and dysfunction of right ventricle, mild dilatation of inferior vena cava and moderate tricuspid insufficiency, with a peak velocity of 3, 3 m/s, which predicts a systolic pu...

It is well known that cardiopulmonary complications are often associated to subarachnoid haemorrhage. For appropriate therapeutic managing it is very important to distinguish acute coronary syndrome from neurogenic myocardial injury, which is a reversible condition. Furthermore, because the hearts of brain dead patients may be utilized for therapeutic purpose, it has became of importance to rule out erroneous diagnosis of cardiac ischemia in order to avoid rejection of hearts potential suitable for transplantation.We present a report of two female patients affected by cardiac complications caused by aneurismal subarachnoid haemorrhage admitted to our neurosurgical intensive care department.

We present a report concerning two patients who developed a ventricular septal defect (VSD) complicating an acute myocardial infarction (MI) admitted to our intensive care unit last year. Clinical casesA 77-year-old, diabetic woman, without a prior history of hypertension and cardiac disease was admitted to our department for anterior acute MI about 6 h after the onset of symptoms. The ECG showed ST elevation in anterior leads. The Troponin I level was 88 ng/ml. She underwent emergency coronary arteriography, which showed three vessels disease. The culprit lesion was a sub-occlusive stenosis with thrombus in the mid-left anterior descending artery-a type B2 lesion, according to the AHA/ACC classification-with TIMI I distal flow. A primary angioplasty was performed with implantation of a TITAN 2 2.5 9 16 at 12 atm, after a pre-dilatation of the lesion with a balloon Fire Star 2 9 15 at 12 atm. The final result was TIMI II-III flow without any residual narrowing. Moreover, an eccentric 90%, focal stenosis of RCA and proximal stenosis of MO2, were detected.Echocardiogram showed an apical aneurysm and an ejection fraction of about 45%, without mitral insufficiency. Diastolic flow velocities were: peak E = 0.92 m/s, with a deceleration time of 260 ms and peak A = 1.07 m/s (E/A ratio = 0.90).The patient was treated with Aspirin, Clopidogrel, ACE inhibitors and Metoprolol.Six hours after PCI, Troponin I was decreased to 56 ng/ ml. Moreover, the ST elevations were reduced.After about 24 h, the patient suddenly complained of dyspnoea. The heart rate was 105 beats/min, blood pressure was 95/60 mmHg. Physical examination revealed tachypnoea, pulmonary rales and a 3/6 Levine holosystolic murmur on the left sternal border. She was also observed to be oliguric. The ECG again showed ST segment elevation in the anterior leads, and the Troponin I was 22 ng/ml.The beta blocker medication was discontinued, and inotropic agents (Dobutamine and Dopamine at 5-10 mcg/ Kg/m), oxygen and Furosemide were administered. Transthoracic echocardiography confirmed abnormalities of regional motion, furthermore the ejection fraction tended to increase to 50%. Evaluation of diastolic function revealed an inversion of E/A ratio ([1). In addition the right ventricle was mildly dilated, but the ratio of right/left ventricular diastolic diameters remained \2/3; right ventricular systolic function was preserved (tricuspid annular systolic motion = 25 mm).Colour-Doppler examination demonstrated a moderate left to right shunt through a small defect in the apical segment of interventricular septum (Fig. 1). In the absence of tricuspidal regurgitation, a pulmonary arterial pressure was not detectable.The patient was promptly transferred to cardiac surgery where an intra-aortic balloon pump (IABP) was first inserted, to allow further stabilization, and an emergency operation was then carried out. This included a coronary artery bypass graft to the RCA and concomitant surgical