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The majority of myxomas are located in the left atrium (75%) followed by the right atrium (20%). In rare cases, myxomas can be found in the ventricles, with 2.5% reported for myxomas in the left ventricle. Systemic emboli, mostly cerebral, occur in two thirds of such patients, while coronary emboli are rare. Here we report a case of left ventricular myxoma causing infero-postero-lateral myocardial infarction, successfully treated by intracoronary thromboaspiration of myxoma embolus.

Misplacement of a permanent pacemaker lead has been described in several locations but rarely in the left ventricle. Less commonly, as described in our report, malposition may occur when the lead perforates the interatrial septum and extends across the left atrium and through the mitral valve into the left ventricle. The actual incidence of this pacemaker complication is unknown. Consequences may include perforation and systemic or cerebral thromboembolic events. We report the case of a patient with unintentionally misplaced left heart pacemaker lead admitted for neurological symptoms consistent with embolic stroke. The patient was on aspirin when symptoms occurred. The lead misplacement was not recognized at the time of implantation. Pacing threshold was normal. A 12-lead electrocardiogram showed right bundle branch block configuration paced complexes. By two-dimensional and transesophageal echocardiography, the pacemaker lead was carefully evaluated. The pacemaker lead crossed the interatrial septum, the left atrium, the mitral valve to be implanted in the left ventricular endocardium. To avoid the risk of future embolization, it was felt that the lead should be removed and right ventricular pacing established, once anticoagulation treatment was initiated. Successful percutaneous lead replacement was accomplished without sequelae. Measures to avoid lead misplacement are suggested.

Background: The aim of the study was to assess the role of oral anticoagulant therapy in patients with dilated cardiomyopathy at risk of embolic complications., Methods: We studied retrospectively two hundred thirty-six patients with dilated cardiomyopathy; sixty-eight cases, with intracavitary thrombosis at cross-sectional echocardiography (17 patients), embolic episodes (22), N.Y.H.A. functional class IV (38), chronic atrial fibrillation (23) or with a combination of such conditions, were treated with warfarin. The cumulative period of exposure to embolic events during follow-up was 814 years in the whole population in the absence of anticoagulant treatment and 213 years during treatment., Results: The rate of new embolic events was 1.6 and 0 for 100 patients-years for the two periods respectively. The difference was not statistically significant. No clinically relevant haemorrhagic complication was seen during treatment., Conclusions: Oral anticoagulant therapy may be safely given to subgroups of patients with dilated cardiomyopathy at risk of embolic episodes, following empirical guidelines, provided a careful clinical and laboratory monitoring is carried on, even if no definite conclusion may be obtained about the efficacy of this treatment from a non-randomized study with low rates of new embolic events.

Two cases of embolic infective endocarditis on bicuspid aortic valve are described. The trans-thoracic and trans-esophageal echocardiographic aspect could leave easily suppose the possibility of embolism. The prophylactic surgical treatment, during the active phase, also if the indication is debated, could have probably avoided the serious consequences of embolism.

The aim of this study is to present a relatively rare case of paradoxical arterial embolism, found in a patient who was sent to us for serious pulmonary embolism. Taking into account that the foramen ovale, despite being functionally competent, remains anatomically patent in 30% of the adult population, we cannot neglect the possibility of a paradoxical embolism, in the presence of a sudden embolic limb ischemia unless heart pathology or aortic lesions can be held responsible. Furthermore it must not be forgotten that deep venous thrombosis in the lower limbs or in the pelvic plexus may go unobserved on a purely clinical evaluation.

The Authors report their clinical experience in superior mesenteric artery embolism: 10 arterial embolisms (71%) collected from a series of 14 obstructions of the superior mesenteric artery. The main interval from the beginning of the symptomatology to hospital admission was 48 h. Laparotomy was performed in all ten patients; gangrenous bowel was resected in 2 and 2 had an embolectomy of the superior mesenteric artery without intestinal resection. The remaining 6 patients had laparotomy alone and died. The Authors emphasize the difficulty in recognizing the disease at an early stage and suggest to contemplate in patients at risk with a persistent abdominal pain, the possibility of a superior mesenteric artery embolism.

Atheroembolism, a systemic vascular disease. Cholesterol crystal embolization (CCE) is an infrequent but serious disorder that is often an unrecognized medical problem. CCE may occur spontaneously from eroded atherosclerotic plaques or most frequently following procedures such as angiography, angioplasty, cardiac catheterization, anticoagulant therapy and aortic surgery. CCE predominantly affects elderly males with a frequent history of hypertension, atherosclerotic vascular diseases and renal insufficiency. CCE may result in protean clinical manifestations and may produce a spectrum of functional impairment. Confusion over the disease's natural history arises because the difficulty of establishing an antemortem diagnosis, and because the laboratory findings are non-diagnostic and non-specific. The mortality was 81% and the causes of death was most often due to multiorgan failure especially renal involvement. The definitive diagnosis depends upon finding the presence of intravascular cholesterol crystal in biopsy or autopsy specimens. The skin, muscle and kidney were the three most common sites for obtaining a premortem diagnostic biopsy.

An echocardiographic study of 50 patients with cerebral infarction confirm the importance of this technique in the diagnosis of cerebral ischaemia originating in a cardiac embolism, an importance that has already been underlined by others. The particular value of this technique in young patients in relation to possible treatment is also pointed out.

The Authors, after reviewing recent years works, have referred aetiological, physiopathological, diagnostic and treatment data concerning renal artery embolism. The study, completed with report of one personal case, has allowed to emphasize on the importance of selective angiography which, among others examens proposed, is the only one able to give precise evaluation of vascular trouble. Emphasis is also given, except for unusual, cases, on the necessity of surgical management (early embolectomy or delayed one) that, giving a sound evaluation of parenchimal damage, also gives a considerable chance of good outcome.