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We describe a case of a 56 year-old man with a history of chest pain. No evidence of myocardial ischemia or arrhytmias was observed. Echocardiographic examination in Emergency Department evidenced aortic root dilatation. Angio CT excluded aortic dissection. Trans esophageous Echocardiography (TEE) correctly identified an arterial fistula between the right coronary artery and superior vena cava, confirmed by angio CT 3-D reconstruction and coronarography. The definitive diagnosis was made after integrated approach (using TTE, TEE, CT, coronarography). The anatomic features of the fistula and the aortic root were examinated. Actually the patient is being followed with serial clinical and echocardiography examination for monitoring hemodynamic overload by fistula and size of aortic root for potential surgical correction. Current literature for incidence, diagnosis and the treatment of coronary fistulas is discussed.

Cerebral ischemia is among the principal causes of mortality and morbidity in industrialized countries being responsible of 10-12% of all deaths and of an elevated number of permanent disability. The cardio-embolic forms may be responsible of the 30-35% of cerebrovascular acute syndrome, nevertheless in a significant percentage of cases, especially among young people, cerebral ischemic episodes are not induced by these cardio-embolic forms: these cases are defined as cryptogenetic stroke/TIA. In these patients cardiac abnormalities represented by an aneurysm of the interatrial septum (ASA) and by a patent foramen ovale (PFO) have been frequently observed. The purpose of our prospective, study was to evaluate, through transthoracic echocardiography and tissue harmonic imaging (ETT-THI), the prevalence of ASA in the general population (group A) and the prevalence of ASA-FOP in a subgroup of patients with recent episode of cryptogenetic ischemic stroke/TIA (group B). We studied in a prospective manner from January 1 2003 to October 31t 2004 n. 5.631 patients. The presence of ASA was found in 3.2% of patients of group A, while in patients of group B we identified an ASA in 32% and a POF in 42% of the cases. Using a ETT-THI, our study shows in a wide range of a non selected population a prevalence of ASA greater than in previous studies. Such high prevalence in the general population of patients submitted to echocardiography and the higher frequency in subjects with recent cryptogenetic stroke, suggests to search carefully these abnormalities at the level of the interatrial septum using the harmonic imaging method.

A total of 90 AMI patients (80 male, 10 female; mean age: 62 years, range: 36-70 yrs) who were admitted to the coronary care unit within six hours of the onset of symptoms were evaluated for the following: the incidence and variability of complex ventricular ectopic beats (classes Lown III-V) in the acute, subacute and chronic phases of myocardial infarction. The diagnostic utility of Holter monitoring and treadmill exercise testing was compared so as to reveal complex ventricular ectopic beats. The relation between complex ventricular ectopic beats and left ventricular dysfunction was determined using the echocardiographic technique (ejection fraction, fractional shortening). The hospital mortality rate was 6.6% (6/9 patients) while the post-hospital mortality rate was 3.5% (3/84 patients). The prevalence rate of complex ventricular ectopic beats detected by Holter monitoring was respectively: 85.5% (77/90 patients) in the acute phase, 8.5% (7/80) at the 72nd hour, 18.5% (15/80) in the pre-discharge phase. At 1, 3, 6 and 12 months the prevalence rate was respectively 35% (27/77 patients), 28.8% (22/77), 24.6 (19/77), 24.6% (19/77). A high variability in arrhythmic groups was found. Each group was composed of new arrhythmic patients and stable arrhythmic patients, in addition to a small number of patients who were arrhythmic in the preceding control but no arrhythmic in the following control. This specific analysis of various groups revealed that the pre-discharge phase is the period with the highest number of "stable arrhythmic" patients (4 Holter positive out of 5) compared to the 1st month (3 Holter positive out of 4) and the 3rd month (2 Holter positive out of 3).(ABSTRACT TRUNCATED AT 250 WORDS)