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It was suggested that Doppler study of pulmonary venous flow (PVF) in combination with mitral flow is useful to evaluate ventricular function. In order to investigate the utility of PVF study in patients with total A-V block treated with pacemaker DDD, we performed transesophageal echocardiography pulsed Doppler of PVF and mitral flow in 12 patients. We measured the following parameters in PVF: peak systolic velocities (S1 and S2), peak diastolic velocity (D) reversal atrial flow diastolic deceleration time. In mitral flow we measured: E wave, A wave and deceleration time of E. We compared our results with the same patients with pacemaker inhibited. In patients with total A-V block with pacemaker inhibited we reported one systolic wave of PVF, a larger D wave with a shortened deceleration time. The PVA seems to disappear. Transmitral flow slowed a higher E wave in patients A-V block with pacemaker inhibited. In patients with total A-V block stimulated by DDD pacemaker we restored the atrioventricular sequentialty; therefore electric stimulation determines the onset of S1 peak and the reduction of S2 peak and the systematic presence of the atrial-pulmonary regurgitant wave.

Cardiac evaluation of stroke or transient ischemic attack (TIA) patients includes transthoracic and transesophageal echocardiography to identify potential cardiac source of embolism. In the present study transesophageal echocardiography was performed in 53 consecutive patients with non valvular atrial fibrillation and a previous embolic stroke. All patients were referred to our department because of an episode of atrial fibrillation. They all underwent computed tomography (CT) scan: 31 patients had a positive scan whereas 22 had a negative scan with a positive history of TIA diagnosed from a neurologist during hospitalization. In the group of 31 patients with a positive scan 9 patients with no history of a previous ischemic attack were found. The transesophageal echocardiography was performed in all the study subjects: 7 patients had a thrombus in the left atrial appendage, 2 patients had a thrombus in the right atrium. Spontaneous echo contrast was reported in 15 patients. Evaluating the interatrial septum we observed a patent foramen ovale in 4 patients, a defect in 2 patients and a fossa ovalis aneurysm in 3 patients. The mitral valve analysis showed a leaflet prolapse in 3 patients. The entire thoracic aorta was imaged in each patient: in 12 an abnormal atherosclerotic plaque was found. Transesophageal echocardiography is an important component of the comprehensive evaluation of potential sources of embolism in patients with ischemic cerebral attack and nonrheumatic atrial fibrillation.

Doppler evaluation of pulmonary venous flow (PVF) and of mitral flow (MF) can be useful to understand left ventricular function. It is well known that left bundle branch block (LBBB) can influence ventricular function. The aim of the present study was to evaluate the role of LBBB induced by ventricular pacing on cardiac performance. We performed transesophageal echocardiography (TEE) in 10 patients affected by sick sinus syndrome (SSS) treated with a permanent pacemaker (VDD modality). We evaluated PVF and MF and compared the pattern from the same patients in sinus rhythm and during cardiac pacing. We observed an increase in the reversal flow in the pulmonary vein during atrial contraction. The diastolic flow of pulmonary vein increased during cardiac pacing. The MF showed an increase in deceleration time. Our results suggest that LBBB is associated with a reduction in ventricular function. This phenomenon induce a higher contribution of atrial contraction to ventricular function.

Reasons why nurses left a general Hospital were analyzed through a questionnaire sent to all nurses who abandoned their position over the last 5 years (218). 50.6% of these nurses do not live in Lombardy region. 127 (57.7%) answered the questionnaire. 35% of whom answered the questionnaire would get back to work in the hospital. The main reason for hospital leave is related to family reasons (children and parents) for registered nurses and to shift work state enrolled nurses. Low salary is the main problem for 21-30 years old nurses. According to nurses who answered the questionnaire, more efficient recruitment and retention strategies should include higher salaries, riqualification of the profession in general and improvement of working conditions and organization.