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Certain congenital cardiac defects may go undetected for several years due to lack of symptoms and signs. The natural history of ventricular septal defects depends on the size of the defect and on the pulmonary resistance. In adults congenital heart disease, ventricular septal defects represent about 10% of the cases. However, the finding of a ventricular septal defect in an elderly individual >80 years of age is extremely uncommon and only two cases have been reported in a living patient, as an accidental finding. We describe a case of an asymptomatic ventricular septal defect associated with interventricular septal hypertrophy, aortic regurgitation, mitral stenosis and regurgitation in an 83-year-old Italian man before a surgical treatment for inguinal hernia repair. To our knowledge, this is the third report of a ventricular septal defect in a living elderly individual >80 years of age., (Copyright 2008 Elsevier Ireland Ltd. All rights reserved.)

Unlabelled: Non-compaction of the ventricular myocardium (LCVM) is a rare disorder of myocardial morphogenesis usually diagnosed in paediatric age. The diagnosis was echocardiographically made on the basis of a reported spongeous/compacted ratio >2 in one or more segments of the left ventricle during the diastolic period. We aimed to test the diagnostic accuracy of cardiovascular magnetic resonance (CMR) imaging in distinguishing pathological left ventricular non-compaction., Methods: We collected a consecutive series of 8 patients, 5 males and 3 females, with a mean age of 14.9 years with non-compaction of left ventricular myocardium. All patients were admitted in our divisions of cardiology. In all cases the diagnosis was performed by echocardiography. The diagnosis was obtained when the spongeous/compacted ratio was >2 in one or more segments of left ventricle, evaluated in systolic and diastolic period. In the end we completed the diagnosis by scanning with a Signa HD 1.5 T (GE, Milwaukee, USA) the same 8 patients affected by non compaction of ventricular myocardium. In all patients cardiac-gated T1 and T2 black-blood FSE images in short axis and in four-chamber horizontal long axis were obtained. Breath hold cine MR sequences (FIESTA) were performed, covering the whole left ventricle in short-axis plane and in four-chamber view. A segmented inversion-recovery fast gradient echo sequence (IR-FGE) was performed in the short-axis plane of the LV and in four-chamber-view after Gadolinium injection in 8 patients affected by non compaction of left ventricle. At the end of examination the spongeous/compacted ratio >2 was calculated in all involved segments of the left ventricle in diastole., Results: In all cases we demonstrated by echocardiography an involvement of the ventricular apex. In 3 cases the structural alterations involved also lateral wall of left ventricle. Magnetic resonance evaluation showed that involvement demonstrated by the echocardiogram was the same: ventricular apex involved in every patient, lateral wall in 3 and all segments in 2. However the spongeous/compacted ratio was >>2 in all patients, with a mean value of 3,1., Conclusions: Although our data refer to a small population of patients and need further confirmation, they suggest that it seems reasonable increase the cut-off for spongeous/compacted ratio from a value of 2 to 2.5 for non-compaction diagnosis when high-resolution magnetic resonance is used., (Copyright (c) 2008 Elsevier Ireland Ltd. All rights reserved.)

Background: The prevalence of primary cardiac neoplasms is approximately 0.3% and these masses should be distinguished from many of other primary and secondary processes that can occur in the heart. Further assessment of the left ventricular mass presents important clinical implications. Cardiovascular magnetic resonance was used., Clinical Case: An asymptomatic 12-year-old child was referred for cardiovascular magnetic resonance imaging to further assess a left ventricular mass found after an echocardiography, executed for assessment for sport activity. His past medical history was absolutely negative. The patient was in optimal state of health. The EKG showed an aspecific ST elevation. A hamartoma was diagnosed. A surgical approach was performed. After 7 days the patient is in good condition.

Takotsubo Cardiomyopathy is characterized by a reversible systolic left ventricular apical ballooning. A new pattern of dyskinesia in the absence of angiographic evidence of coronary artery stenosis has been indicated like a variant of takotsubo cardiomiopathy: mid-ventricular akinesis with preservation of apical and basal contractilities revealed at echocardiograms and ventriculographies. We report the case of a 65 years old patient with this pattern, reverted in 4 weeks.

Background: Takotsubo cardiomyopathy is a disorder that has been appreciated only recently. In most of reported cases, this syndrome mimes an acute myocardial infarction. Till this moment no data are available from literature about the treatment in the acute phase of this disease., Aim of the Study: In our multicentric experience we have retrospectively looked at the benefits of a treatment with ACE-inhibitors, beta-blockers, Aspirin and calcium channels blockers, started until the early phases of the disease and continued for 30 days, in 36 patients affected by Takotsubo cardiomyopathy. We chose as endpoint of the study the efficacy of the used drug in improving left ventricular myocardial function and the rapidity of the effects of the same drug.bethods: from an international registry about the Takotsubo cardiomiopathy, co-ordinate by our research group, we evaluated the long term efficacy of some drugs, administrated like single treatment in some patients., Results: Obtained data did not show any statistically significant difference in the percentages of improvement in the left ventricle ejection fraction evaluated at the admission to the hospital, before the discharge and after 30 days of treatment between each treated group and the control group of non-treated patients. No significant differences were found in hospitalization times between treated patients and controls. None of our patients experienced during the observation period a relapse of the disease., Conclusions: The results of our survey suggest that a chronic treatment with beta-blockers, ACE-inhibitors, calcium channels blockers and aspirin does not provide any benefit in patients with Takotsubo cardiomyopathy. Thus, it seem to be important an early correct differential diagnosis to avoid any chronic treatment in these patients.

In 2005 Syeda et al. reported that the major factor limiting the long term of cardiac transplantation is the development of accelerated arteriosclerosis that occurs in the coronary arteries of the cardiac allograft. Transplant arteriosclerosis is characterized by diffuse, uniform, concentric narrowing of the artery by a fibrous proliferation of sub-intima cells. This atherosclerosis was estimate to occur in approximately 50% of patients by 5 years after transplantation. Unfortunately, as a consequence of cardiac denervation, symptoms are often atypical or completely absent. When these are present, the symptoms are those typical of effort angina. Very uncommon is the acute coronary syndrome. We present a case of a patient, underwent to a cardiac transplant for ischemic cardiomyopathy that after 10 years from the transplantation, was affected by an anterior myocardial infarct. In our case the presence of a single noncircumferential atherosclerotic plaque makes to think that it is a consequence of a patient's systemic atherosclerotic disease better then the result of the heart transplant's typical atherosclerosis.

Beta-blocker is the first line drug therapy for congenital long QT syndrome. However, in some children this drug is ineffective. In a non-responder patient, Shimizu et al. used Mexiletine to suppress the ventricular arrhythmias, obtaining a good result. In the high risk patient, the ICD is necessary. However the implantation of a device in small children can have technical problems. We report a case of a child affected by long QT syndrome with recurrent episodes of syncope due to self-limiting torsade de point/ventricular fibrillation, successfully treated by an association of mexiletin and propanolol, and in whom an ICD was implanted with a new subcutaneous approach.