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Clinical, electrocardiographic, radiological, hemodynamic and angiocardiographic data of 12 patients with ventricular septal defect (VSD) associated to aortic regurgitation (AR) have been analyzed. The trend of evolution of the AR has been evaluated and angiographic criteria to make a correct diagnosis have been pointed out. Nine patients have been followed up for a mean of 3.8 years. The severity of AR seemed to increase only in three cases: this demonstrates that AR associated to VSD is not always a progressive disease. The usefulness of various radiological views in evidencing the anatomy of both VSD and aortic valve has been discussed and findings of left ventriculogram and aortogram are detailedly described. The site of VSD and the type of lesion of the aortic valve may be crucial for indicating surgical intervention and its type. Indication for surgery is briefly discussed. Surgical technics are shortly summarized.

16 cases of left ventricular-right atrial communication are reported. The most consistent clinical features, suggestive of this condition, were: auscultatory findings of V.S.D., electrocardiographic patterns of right atrial enlargement and biventricular hypertrophy, considerable right atrial enlargement coexisting with signs of left-sided cardiac enlargement and increased polmonary vascularity to Xray examination, echocardiographic fluttering of the tricuspid valve. Cardiac catheterization revealed an increased oxygen content in the right atrial or ventricular blood without the passage of the catheter through an A.S.D. The definitive diagnosis was established by left ventricular angiocardiography which demonstrated immediate opacification of a dilated right atrium through a septal defect; the location of the septal defect in the cardiac septum was attempted. In patients who suffered from a large left to right shunt were recommended for surgical treatment also in view of the relatively bad tolerance of this defect and low operative risk. There were two deaths: one baby died of early congestive failure. 9 cases were operated upon with one immediate postoperative death. The remaining, controlled by clinic follow-up, had good results.

Ten cases of total abnormal pulmonary venous connection are described: 5 cases with supracardiac drainage, 4 with sub-diaphragmatic drainage and one with intracardiac drainage, 3 cases with supradiaphragmatic drainage, and 4 with subdiaphragmatic drainage have undergone surgical treatment. Some developmental, embryological and pathophysiological signs of this malformation are reported. The more significant clinical and instrumental data arising from our personal cases and from review data are discussed. In the clinical description a distinction is made between cases with venous obstruction and those without venous obstruction. The importance of hemodinamic tests, which allow us to identify the type of connection present, and whether or not there are associated malformations, are underlined. The natural history is conditioned by the presence of venous obstruction, by the value of the pulmonary hyper-flow and by the possibility of communication between the two circulatory districts. The prognosis of the cases with marked obstruction, and of those with irreversible cardiac failure is one of rapid deterioration: surgical correction in the first months of life is the only therapeutic possibility, even if the death risk is high. The cases without venous obstruction, and with fairly normal weight and circulation, are corrected surgically at a later age with much more favourable results.

60 patients with clinical signs of coronary artery disease who had a hemodynamic examination were studied. The study of the regional dynamics using the deformation as a vectorial time-dependent parameter and the pressure-length loops, was carried out on a total of 420 parietal regions of the left ventricle: the basal ventriculography, the post-extrasystolic potentiation and the ventriculography after nitroglycerin were evaluated. The dynamic regional pattern was correlated with clinical-enzimatic signs of necrosis in the electrocardiogram. The possibility of correlating signs of necrosis with particular patterns of hypokinesia, akinesia, dyskinesia which differ from corresponding "static" forms of asynergy in active pressure development and deformation (even in a brief systolic interval) seems to confirm the physiopathologic interpretation of the regional phenomenon based on the ratio between viable not viable myocardium -- as primary cause.

The angiographic findings of 10 cases with azygos (AC) or hemiazygos (HC) continuation of the inferior vena cava (IVC), associated with other congenital heart disease (0.5%), are described. Abdominal situs solitus was present in 7 cases, left isomerism in 3. In 5 cases IVC was to the left to the spine, bilateral in one. In 6 cases there was AC, HC in 2; in one both types of continuation were documented. It is important that this venous anomaly be diagnosed before cardiac catheterization; manipulation of the probe may be very difficult when saphenous approach is used. The correct use of the terms "Azygos", "Hemiazygos" and "Accessory Hemiazygos" are discussed.

Three cases of traumatic tricuspid insufficiency are reported. The most consistent clinical and noninvasive cardiovascular findings were: previous nonpenetrating thorax trauma; non holosystolic murmur which increased slightly during inspiration on standing; electrocardiographic patterns of right atrial enlargement and right bundle branch block; unusual bulge along the mid-left heart border, seen on chest x-ray examination suggesting ventricular aneurysm; striking right ventricular dilatation wit paradoxical movement of the ventricular septum on ECHO. Cardiac catheterization led to definitive diagnosis by demonstrating a massive tricuspid valve incompetence with "ventricularisation" of the right atrial pressure. Some dyskinetic areas of the right ventrice, most likely due to the full-thickness contusion of the miocardial wall, seen on the right cineangiography, confirmed the diagnosis. The long-term clinical and haemodynamic follow-up was useful for monitoring the evolution of the disease. Surgery should be recommended in the presence of right-sided heart failure not relieved by adequate medical treatment, in view of the low operative risk.

A study was carried out on 59 patients with significant stenosis (greater than or equal to 75%) in at least one coronary vessel. For each parietal region of the left ventricle the pattern of contraction was defined through a study of the regional deformation as vectorial time-dependent parameter and of the construction of the pressure-length loops. The different models obtained in basal conditions and through intervention (nitroglycerin and post-extrasystolic potentiation) were correlated with experimental data on ischemic alterations of the regional mechanical performance.